Chhim Kolab, Mburu Gitau, Tuot Sovannary, Sopha Ratana, Khol Vohith, Chhoun Pheak, Yi Siyan
KHANA Center for Population Health Research, No. 33, Street 71, Phnom Penh, Cambodia.
Division of Health Research, Lancaster University, Lancaster, UK.
AIDS Res Ther. 2018 Nov 17;15(1):20. doi: 10.1186/s12981-018-0205-z.
Adolescents living with HIV on antiretroviral therapy (ART) have worse treatment adherence, viral suppression, and mortality rates compared to adults. This study investigated factors associated with viral non-suppression among adolescents living with HIV in Cambodia.
A cross-sectional study was conducted in August 2016 among 328 adolescents living with HIV aged 15-17 years who were randomly selected from 11 ART clinics in the capital city of Phnom Penh and 10 other provinces. Clinical and immunological data, including CD4 count and viral load, were obtained from medical records at ART clinics. Adolescents were categorized as having achieved viral suppression if their latest viral load count was < 1000 ribonucleic acid (RNA) copies/mL. Multivariate logistic regression analysis was performed to identify factors independently associated with viral non-suppression.
The mean age of the participants was 15.9 years (SD = 0.8), and 48.5% were female. Median duration on ART was 8.6 (interquartile range = 6.0-10.6) years. Of total, 76.8% of the participants had achieved viral suppression. After adjustment for other covariates, the likelihood of having viral non-suppression remained significantly lower among adolescents who were: older/aged 17 (AOR = 0.46, 95% CI 0.21-0.98), had been on ART for more than 9 years (AOR = 0.35, 95% CI 0.19-0.64), had most recent CD4 count of > 672 (AOR = 0.47, 95% CI 0.26-0.86), had a relative as the main daily caregiver (AOR = 0.37, 95% CI 0.17-0.80), and did not believe that there is a cure for AIDS (AOR = 0.40, 95% CI 0.21-0.75) compared to their reference group. The likelihood of having viral non-suppression also remained significantly higher among adolescents who had first viral load > 628 RNA copies/mL (AOR = 1.81, 95% CI 1.05-4.08) and among those who were receiving HIV care and treatment from an adult clinic (AOR = 2.95, 95% CI 1.56-5.59).
The proportion of adolescents living with HIV with viral suppression in this study was relatively high at 76.8%, but falls short of the global target of 90%. Programs targeting younger adolescents and adolescents in transition from pediatric to adult care with a range of interventions including psychosocial support and treatment literacy could further improve viral suppression outcomes.
与成年人相比，接受抗逆转录病毒疗法（ART）的青少年艾滋病毒感染者的治疗依从性、病毒抑制率和死亡率更差。本研究调查了柬埔寨青少年艾滋病毒感染者中与病毒未抑制相关的因素。
2016年8月对328名年龄在15至17岁的青少年艾滋病毒感染者进行了一项横断面研究，这些青少年是从首都金边的11家抗逆转录病毒治疗诊所和其他10个省份中随机选取的。临床和免疫学数据，包括CD4细胞计数和病毒载量，从抗逆转录病毒治疗诊所的病历中获取。如果青少年最近的病毒载量计数<1000核糖核酸（RNA）拷贝/毫升，则被归类为实现了病毒抑制。进行多变量逻辑回归分析以确定与病毒未抑制独立相关的因素。
参与者的平均年龄为15.9岁（标准差=0.8），48.5%为女性。抗逆转录病毒疗法的中位疗程为8.6年（四分位间距=6.0-10.6年）。总体而言，76.8%的参与者实现了病毒抑制。在对其他协变量进行调整后，以下青少年病毒未抑制的可能性仍然显著较低：年龄较大/17岁（调整后的比值比[AOR]=0.46，95%置信区间[CI]0.21-0.98）、接受抗逆转录病毒疗法超过9年（AOR=0.35，95%CI0.19-0.64）、最近CD4细胞计数>672（AOR=
