Steinbrink Julie, Imlay Hannah, Rao Krishna, Riddell James
Department of Internal Medicine, University of Michigan, Ann Arbor, MI, USA.
Division of Infectious Diseases, Duke University Hospital, Durham, NC, USA.
SAGE Open Med. 2019 May 14;7:2050312119851006. doi: 10.1177/2050312119851006. eCollection 2019.
Despite many advances in medicine, not all individuals with HIV are able to achieve complete virologic suppression. This retrospective study identifies variables associated with persistent HIV viremia in an academic clinic.
We studied 66 HIV-infected patients with a viral load of >200 copies/mL over 1 year, with controls matched 1:1 via a propensity score utilizing age at diagnosis, era of diagnosis, gender, and initial CD4 count. We collected data on multiple variables including medications, adherence, comorbidities, hospitalizations, and insurance status. Conditional logistic regression was used for unadjusted and adjusted analyses.
A total of 66 viremic cases/matched controls were included. Fewer viremic patients were on antiretroviral therapy for all 12 months (45% vs 77%; odds ratio: 0.33, = .018) and fewer were of white race (52% vs 70%; odds ratio: 0.49, = .053). Hospitalization (11% vs 3%; odds ratio: 10, = .028), underinsurance (20% vs 1%; odds ratio: 5.87, = .022), and conflicting personal beliefs about their disease (17% vs 3%; odds ratio: 5.5, = .027) were more common in viremic patients. Psychiatric illness increased the odds of viremia in patients who had four or more visits (odds ratio: 1.63/6.64 with four/five clinic visits, respectively).
Psychiatric illness is an important contributor to the presence of persistent viremia in HIV-infected patients and deserves further study.
尽管医学取得了诸多进展，但并非所有感染HIV的个体都能实现完全的病毒学抑制。这项回顾性研究确定了在一家学术诊所中与持续性HIV病毒血症相关的变量。
我们研究了66例在1年多时间里病毒载量>200拷贝/毫升的HIV感染患者，并通过倾向评分以1:1的比例匹配对照组，匹配因素包括诊断时的年龄、诊断时代、性别和初始CD4细胞计数。我们收集了关于多种变量的数据，包括药物治疗、依从性、合并症、住院情况和保险状况。采用条件逻辑回归进行未调整和调整分析。
共纳入66例病毒血症病例/匹配对照组。在整个12个月中接受抗逆转录病毒治疗的病毒血症患者较少（45%对77%；比值比：0.33，P = 0.018），白人种族的患者也较少（52%对70%；比值比：0.49，P = 0.053）。住院（11%对3%；比值比：10，P = 0.028）、保险不足（20%对1%；比值比：5.87，P = 0.022）以及对自身疾病存在矛盾的个人信念（17%对3%；比值比：5.5，P = 0.027）在病毒血症患者中更为常见。精神疾病增加了就诊4次或更多次患者的病毒血症几率（就诊4次/5次时的比值比分别为1.63/6.64）。
精神疾病是HIV感染患者持续性病毒血症存在的一个重要因素，值得进一步研究。
