Palmer Alexis, Gabler Karyn, Rachlis Beth, Ding Erin, Chia Jason, Bacani Nic, Bayoumi Ahmed M, Closson Kalysha, Klein Marina, Cooper Curtis, Burchell Ann, Walmsley Sharon, Kaida Angela, Hogg Robert
British Columbia Centre for Excellence in HIV/AIDS, Vancouver, BC The Ontario HIV Treatment Network Dalla Lana School of Public Health, University of Toronto St. Michael's Hospital, Toronto, ON Department of Medicine, McGill University Health Centre, Montreal, QB The Ottawa Hospital Research Institute, University of Ottawa, Ottawa Toronto General Research Institute, University Health Network, Toronto, ON Faculty of Health Sciences, Simon Fraser University, Burnaby, BC, Canada.
Medicine (Baltimore). 2018 Jun;97(22):e10562. doi: 10.1097/MD.0000000000010562.
Describe the prevalence and covariates of viral suppression and subsequent rebound among younger (≤29 years old) compared with older adults.A retrospective clinical cohort study; eligibility criteria: documented HIV infection; resident of Canada; 18 years and over; first antiretroviral regimen comprised of at least 3 individual agents on or after January 1, 2000.Viral suppression and rebound were defined by at least 2 consecutive viral load measurements <50 or >50 HIV-1 RNA copies/mL, respectively, at least 30 days apart, in a 1-year period. Time to suppression and rebound were measured using the Kaplan-Meier method and Life Table estimates. Accelerated failure time models were used to determine factors independently associated with suppression and rebound.Younger adults experienced lower prevalence of viral suppression and shorter time to viral rebound compared with older adults. For younger adults, viral suppression was associated with being male and later era of combination antiretroviral initiation (cART) initiation. Viral rebound was associated with a history of injection drug use, Indigenous ancestry, baseline CD4 cell count >200, and initiating cART with a protease inhibitor (PI) containing regimen.The influence of age on viral suppression and rebound was modest for this cohort. Our analysis revealed that key covariates of viral suppression and rebound for young adults in Canada are similar to those of known importance to older adults. Women, people who use injection drugs, and people with Indigenous ancestry could be targeted by future health interventions.
描述与老年人相比，年轻成年人（≤29岁）病毒抑制及随后病毒反弹的患病率和协变量。一项回顾性临床队列研究；纳入标准：有记录的HIV感染；加拿大居民；18岁及以上；2000年1月1日或之后开始的首个抗逆转录病毒治疗方案至少包含3种单一药物。病毒抑制和反弹分别定义为在1年期间内至少2次连续病毒载量测量值<50或>50 HIV-1 RNA拷贝/mL，且间隔至少30天。使用Kaplan-Meier方法和生命表估计值测量达到抑制和反弹的时间。采用加速失效时间模型确定与抑制和反弹独立相关的因素。与老年人相比，年轻成年人的病毒抑制患病率较低，病毒反弹时间较短。对于年轻成年人，病毒抑制与男性以及联合抗逆转录病毒治疗（cART）开始时间较晚有关。病毒反弹与注射吸毒史、原住民血统、基线CD4细胞计数>200以及开始使用含蛋白酶抑制剂（PI）的方案进行cART有关。年龄对该队列中病毒抑制和反弹的影响较小。我们的分析表明，加拿大年轻成年人病毒抑制和反弹的关键协变量与已知对老年人重要的协变量相似。女性、注射吸毒者和有原住民血统的人可能是未来健康干预的目标人群。
