描述艾滋病病毒治疗的连续性，包括死亡率和失访率：一项纵向队列研究。
A continuum of HIV care describing mortality and loss to follow-up: a longitudinal cohort study.
机构信息
Centre for Clinical Research, Epidemiology, Modelling and Evaluation, Institute for Global Health, University College London, London, UK; National Institute for Health Research Health Protection Research Unit in Blood Borne and Sexually Transmitted Infections at University College London, London, UK.
Public Health England, London, UK; National Institute for Health Research Health Protection Research Unit in Blood Borne and Sexually Transmitted Infections at University College London, London, UK.
出版信息
Lancet HIV. 2018 Jun;5(6):e301-e308. doi: 10.1016/S2352-3018(18)30048-1.
BACKGROUND
The cross-sectional HIV care continuum is widely used to assess the success of HIV care programmes among populations of people with HIV and the potential for ongoing transmission. We aimed to investigate whether a longitudinal continuum, which incorporates loss to follow-up and mortality, might provide further insights about the performance of care programmes.
METHODS
In this longitudinal cohort study, we included individuals who entered the UK Collaborative HIV Cohort (CHIC) study between Jan 1, 2000, and Dec 31, 2004, and were linked to the national HIV cohort database (HIV and AIDS Reporting System). For each month during a 10 year follow up period, we classified individuals into one of ten distinct categories according to engagement in care, antiretroviral therapy (ART) use, viral suppression, loss to cohort follow-up and loss to care, and mortality, and assessed the proportion of person-months of follow-up spent in each stage of the continuum. 5 year longitudinal continuums were also constructed for three separate cohorts (baseline years of entry 2000-03, 2004-07, and 2008-09) to compare changes over time.
FINDINGS
We included 12 811 people contributing 1 537 320 person-months in our analysis. During 10 years of follow-up, individuals spent 811 057 (52·8%) of 1 537 320 person-months on ART. Of the 811 057 person-months spent on ART, individuals had a viral load of 200 copies per mL or less for 607 185 (74·9%) person-months. 10 years after cohort entry, 3612 (28·1%) of 12 811 individuals were lost to follow-up, 954 (26·4%) of whom had transferred to a non-CHIC UK clinic for care. By 10 years, 759 (5·9%) of 12 811 participants who entered the cohort had died. Loss to follow-up decreased and the proportion of person-months that individuals spent virally suppressed increased over calendar time.
INTERPRETATION
Loss to follow-up in HIV care programmes was high and rates of viral suppression were lower than previously reported. Complementary information provided by a longitudinal continuum might highlight areas for intervention along the HIV care pathway, however, transfers outside the cohort must be accounted for.
FUNDING
Medical Research Council, UK.
背景
横向 HIV 护理连续统一体被广泛用于评估 HIV 感染者人群中 HIV 护理计划的成功与否，以及持续传播的潜力。我们旨在研究纵向连续统一体（包含失访和死亡）是否能提供更多关于护理计划表现的见解。
方法
在这项纵向队列研究中，我们纳入了 2000 年 1 月 1 日至 2004 年 12 月 31 日期间进入英国合作艾滋病毒队列（CHIC）研究并与国家艾滋病毒队列数据库（艾滋病毒和艾滋病报告系统）相链接的个体。在 10 年的随访期间，我们根据个体在每个月参与护理、使用抗逆转录病毒治疗（ART）、病毒抑制、失访和失能的情况，将个体归入十个不同的类别，并评估每个阶段的人月比例。我们还为三个不同的队列（2000-03、2004-07 和 2008-09 年的基线进入年份）构建了 5 年的纵向连续体，以比较随时间的变化。
结果
我们纳入了 12811 名个体，贡献了 1537320 人月的随访数据。在 10 年的随访期间，个体在 ART 上花费了 811057（52.8%）人月。在接受 ART 治疗的 811057 人月中，个体的病毒载量<200 拷贝/ml 占 607185（74.9%）人月。队列进入 10 年后，3612（28.1%）名个体失访，其中 954（26.4%）名个体转到了非 CHIC 英国诊所进行护理。10 年内，12811 名进入队列的参与者中，有 759（5.9%）人死亡。失访率下降，个体病毒抑制的人月比例增加。
结论
HIV 护理项目中的失访率很高，病毒抑制率低于之前的报告。纵向连续统一体提供的补充信息可能突出了 HIV 护理途径中需要干预的领域，但必须考虑到队列外的转移。
资助
英国医学研究理事会。
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