亚洲青少年 HIV 感染者行为风险、依从性和病毒学控制的纵向研究。
A Longitudinal Study of Behavioral Risk, Adherence, and Virologic Control in Adolescents Living With HIV in Asia.
机构信息
TREAT Asia/amfAR, The Foundation for AIDS Research, Bangkok, Thailand.
The HIV Netherlands Australia Thailand Research Collaboration (HIV-NAT), The Thai Red Cross AIDS Research Centre, Bangkok, Thailand.
出版信息
J Acquir Immune Defic Syndr. 2019 Jun 1;81(2):e28-e38. doi: 10.1097/QAI.0000000000002008.
BACKGROUND
Adolescents living with HIV (ALHIV) have poorer adherence and clinical outcomes than adults. We conducted a study to assess behavioral risks and antiretroviral therapy outcomes among ALHIV in Asia.
METHODS
A prospective cohort study among ALHIV and matched HIV-uninfected controls aged 12-18 years was conducted at 9 sites in Malaysia, Thailand, and Vietnam from July 2013 to March 2017. Participants completed an audio computer-assisted self-interview at weeks 0, 48, 96, and 144. Virologic failure (VF) was defined as ≥1 viral load (VL) measurement >1000 copies/mL. Generalized estimating equations were used to identify predictors for VF.
RESULTS
Of 250 ALHIV and 59 HIV-uninfected controls, 58% were Thai and 51% females. The median age was 14 years at enrollment; 93% of ALHIV were perinatally infected. At week 144, 66% of ALHIV were orphans vs. 28% of controls (P < 0.01); similar proportions of ALHIV and controls drank alcohol (58% vs. 65%), used inhalants (1% vs. 2%), had been sexually active (31% vs. 21%), and consistently used condoms (42% vs. 44%). Of the 73% of ALHIV with week 144 VL testing, median log VL was 1.60 (interquartile range 1.30-1.70) and 19% had VF. Over 70% of ALHIV had not disclosed their HIV status. Self-reported adherence ≥95% was 60% at week 144. Smoking cigarettes, >1 sexual partner, and living with nonparent relatives, a partner or alone, were associated with VF at any time.
CONCLUSIONS
The subset of ALHIV with poorer adherence and VF require comprehensive interventions that address sexual risk, substance use, and HIV-status disclosure.
背景
与成人相比，感染艾滋病病毒的青少年（ALHIV）的服药依从性和临床结局更差。我们进行了一项研究，以评估亚洲 ALHIV 的行为风险和抗逆转录病毒治疗结果。
方法
2013 年 7 月至 2017 年 3 月，在马来西亚、泰国和越南的 9 个地点，对年龄在 12-18 岁的 ALHIV 和匹配的未感染 HIV 的对照者进行了前瞻性队列研究。参与者在第 0、48、96 和 144 周时完成了音频计算机辅助自我访谈。病毒学失败（VF）定义为≥1 次病毒载量（VL）测量值>1000 拷贝/ml。广义估计方程用于确定 VF 的预测因素。
结果
在 250 名 ALHIV 和 59 名未感染 HIV 的对照者中，58%为泰国人，51%为女性。入组时的中位年龄为 14 岁；93%的 ALHIV 是围产期感染的。在第 144 周时，66%的 ALHIV 是孤儿，而对照者为 28%（P < 0.01）；ALHIV 和对照者饮酒的比例相似（58%比 65%），使用吸入剂的比例相似（1%比 2%），有过性行为的比例相似（31%比 21%），持续使用避孕套的比例相似（42%比 44%）。在接受第 144 周 VL 检测的 73%的 ALHIV 中，中位 log VL 为 1.60（四分位距 1.30-1.70），19%的人发生 VF。超过 70%的 ALHIV 没有透露他们的 HIV 状况。第 144 周自我报告的依从性≥95%的比例为 60%。吸烟、≥1 个性伴侣以及与非父母亲属、伴侣或独自生活，与任何时候的 VF 相关。
结论
依从性较差和 VF 的 ALHIV 亚组需要综合干预，以解决性风险、药物使用和 HIV 状况披露问题。
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