HIV 感染者在美国接受治疗的时间内病毒抑制趋势：一项队列研究，1997 年至 2015 年。
HIV Viral Suppression Trends Over Time Among HIV-Infected Patients Receiving Care in the United States, 1997 to 2015: A Cohort Study.
机构信息
University of Washington, Seattle, Washington (R.M.N., J.C.D., J.M.S., B.M.W., F.M.A., R.J.F., M.M.K., H.M.C.).
Brown University, Providence, Rhode Island (I.B.W.).
出版信息
Ann Intern Med. 2018 Sep 18;169(6):376-384. doi: 10.7326/M17-2242. Epub 2018 Aug 21.
BACKGROUND
Because HIV viral suppression is essential for optimal outcomes and prevention efforts, understanding trends and predictors is imperative to inform public health policy.
OBJECTIVE
To evaluate viral suppression trends in people living with HIV (PLWH), including the relationship of associated factors, such as demographic characteristics and integrase strand transfer inhibitor (ISTI) use.
DESIGN
Longitudinal observational cohort study.
SETTING
8 HIV clinics across the United States.
PARTICIPANTS
PLWH receiving clinical care.
MEASUREMENTS
To understand trends in viral suppression (≤400 copies/mL), annual viral suppression rates from 1997 to 2015 were determined. Analyses were repeated with tests limited to 1 random test per person per year and using inverse probability of censoring weights to address loss to follow-up. Joint longitudinal and survival models and linear mixed models of PLWH receiving antiretroviral therapy (ART) were used to examine associations between viral suppression or continuous viral load (VL) levels and demographic factors, substance use, adherence, and ISTI use.
RESULTS
Viral suppression increased from 32% in 1997 to 86% in 2015 on the basis of all tests among 31 930 PLWH. In adjusted analyses, being older (odds ratio [OR], 0.76 per decade [95% CI, 0.74 to 0.78]) and using an ISTI-based regimen (OR, 0.54 [CI, 0.51 to 0.57]) were associated with lower odds of having a detectable VL, and black race was associated with higher odds (OR, 1.68 [CI, 1.57 to 1.80]) (P < 0.001 for each). Similar patterns were seen with continuous VL levels; when analyses were limited to 2010 to 2015; and with adjustment for adherence, substance use, or depression.
LIMITATION
Results are limited to PLWH receiving clinical care.
CONCLUSION
HIV viral suppression rates have improved dramatically across the United States, which is likely partially attributable to improved ART, including ISTI-based regimens. However, disparities among younger and black PLWH merit attention.
PRIMARY FUNDING SOURCE
National Institutes of Health.
背景
由于 HIV 病毒抑制对于实现最佳治疗效果和预防工作至关重要，因此了解趋势和预测因素对于制定公共卫生政策至关重要。
目的
评估 HIV 感染者（PLWH）的病毒抑制趋势，包括与人口统计学特征和整合酶抑制剂（INSTI）使用相关的因素关系。
设计
纵向观察队列研究。
地点
美国 8 家 HIV 诊所。
参与者
接受临床护理的 PLWH。
测量
为了了解病毒抑制（≤400 拷贝/毫升）的趋势，确定了 1997 年至 2015 年期间的年度病毒抑制率。通过对每个人每年限制一次随机检测的测试和使用逆概率 censoring 权重来解决失随访问题，对结果进行了重复分析。使用联合纵向和生存模型以及接受抗逆转录病毒治疗（ART）的 PLWH 的线性混合模型，来检验病毒抑制或连续病毒载量（VL）水平与人口统计学因素、物质使用、依从性和 INSTI 使用之间的关联。
结果
根据所有 31930 名 PLWH 的检测结果，1997 年时所有检测中病毒抑制率为 32%，而到 2015 年则增加到 86%。在调整后的分析中，年龄较大（每十年比值比 [OR]，0.76 [95%CI，0.74 至 0.78]）和使用基于 INSTI 的方案（OR，0.54 [CI，0.51 至 0.57]）与检测不到 VL 的可能性降低相关，而黑种人种族则与较高的可能性相关（OR，1.68 [CI，1.57 至 1.80]）（P 值均<0.001）。连续 VL 水平也存在类似的模式；当分析仅限于 2010 年至 2015 年时；以及调整依从性、物质使用或抑郁因素时。
局限性
结果仅限于接受临床护理的 PLWH。
结论
美国的 HIV 病毒抑制率已经有了显著提高，这可能部分归因于抗逆转录病毒治疗（包括基于 INSTI 的方案）的改善。然而，年轻和黑人 PLWH 之间的差异值得关注。
主要资金来源
美国国立卫生研究院。
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