Department of Health Promotion, Education, and Behavior, South Carolina SmartState Center for Healthcare Quality (CHQ), Arnold School of Public Health, University of South Carolina, Columbia, SC, United States of America.
Guangxi Center for Disease Control and Prevention, Nanning, Guangxi, People's Republic of China.
PLoS One. 2019 Mar 1;14(3):e0213205. doi: 10.1371/journal.pone.0213205. eCollection 2019.
Limited data are available on clinical outcomes of people living with HIV (PLWH) in China, especially after the implementation of the 2016 national treatment guideline. The objective of the current study is to examine the treatment patterns, clinical outcomes and their associated factors among PLWH in Guangxi, China before and after this new guideline.
Data from three community-based projects conducted at different time points over a period of six years (2012-2017) in Guangxi were analyzed in our study. The interviewer-administered questionnaire was used for data collection. Measures of clinical outcomes were retrieved from the patients' medical records. Descriptive analysis was employed to display treatment patterns and the time trends of clinical outcomes. Chi-square test or ANOVA was used to compare the differences in background characteristics and treatment history between different levels of clinical outcomes.
Among the pooled sample of 4224 participants, 77.3% were receiving antiretroviral therapy (ART), the median CD4 count was 328 cells/mm3, and 82.5% were virally suppressed. An increasing trend in both ART coverage (from 72.1% to 91.2%) and CD4 count (from 318 cells/mm3 to 357 cells/mm3) was observed over time in the three samples, while rates of viral suppression did not show a similar trend. A number of socio-demographic characteristics (e.g., female gender, younger age, Han ethnicity, and employment) and treatment-related variables (e.g., longer durations of HIV diagnosis and ART uptake, lower prevalence of comorbidity, fewer treatment interruptions, and more knowledge on ART) were associated with improved clinical outcomes.
We observed a high rate of viral suppression and increasing trends in ART coverage and CD4 count over six years in Guangxi, China. However, suboptimal clinical outcomes continue to be a problem, particularly among some subgroups of PLWH. Future clinical management strategies should be tailored for PLWH with different sociodemographic characteristics and treatment trajectories.
在中国，关于艾滋病毒感染者（PLWH）的临床结果的相关数据有限，尤其是在 2016 年国家治疗指南实施之后。本研究旨在研究中国广西在实施新指南前后 PLWH 的治疗模式、临床结果及其相关因素。
本研究分析了在六年时间内（2012-2017 年）在广西进行的三个基于社区的项目的数据。使用问卷调查收集数据。从患者的病历中检索临床结果的衡量指标。采用描述性分析来展示治疗模式和临床结果的时间趋势。采用卡方检验或方差分析比较不同临床结果水平之间的背景特征和治疗史差异。
在汇总的 4224 名参与者中，77.3%接受抗逆转录病毒治疗（ART），中位 CD4 计数为 328 个细胞/mm3，82.5%病毒得到抑制。在三个样本中，ART 覆盖率（从 72.1%增加到 91.2%）和 CD4 计数（从 318 个细胞/mm3增加到 357 个细胞/mm3）均呈上升趋势，而病毒抑制率则没有显示出类似的趋势。一些社会人口学特征（例如，女性、年龄较小、汉族和就业）和治疗相关变量（例如，HIV 诊断和接受 ART 的时间较长、合并症的发生率较低、治疗中断次数较少、对 ART 的认识较多）与改善临床结果有关。
我们观察到，在六年的时间里，中国广西的病毒抑制率很高，ART 覆盖率和 CD4 计数呈上升趋势。然而，亚最佳的临床结果仍然是一个问题，特别是在一些特定亚组的 PLWH 中。未来的临床管理策略应针对不同社会人口学特征和治疗轨迹的 PLWH 进行定制。
