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.
J Acquir Immune Defic Syndr. 2019 Jun 1;81(2):e28-e38. doi: 10.1097/QAI.0000000000002008.
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.
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.
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.
The subset of ALHIV with poorer adherence and VF require comprehensive interventions that address sexual risk, substance use, and HIV-status disclosure.
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。
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。
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。
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。
