华盛顿特区按入组状态比较 HIV 感染者的临床结局：一项大型纵向 HIV 队列研究的评估。
Comparison of Clinical Outcomes of Persons Living With HIV by Enrollment Status in Washington, DC: Evaluation of a Large Longitudinal HIV Cohort Study.
机构信息
HIV/AIDS, Hepatitis, STD, and TB Administration, DC Health, Washington, DC, United States.
Department of Epidemiology, Milken Institute School of Public Health, George Washington University, Washington, DC, United States.
出版信息
JMIR Public Health Surveill. 2020 Apr 15;6(2):e16061. doi: 10.2196/16061.
BACKGROUND
HIV cohort studies have been used to assess health outcomes and inform the care and treatment of people living with HIV disease. However, there may be similarities and differences between cohort participants and the general population from which they are drawn.
OBJECTIVE
The objective of this analysis was to compare people living with HIV who have and have not been enrolled in the DC Cohort study and assess whether participants are a representative citywide sample of people living with HIV in the District of Columbia (DC).
METHODS
Data from the DC Health (DCDOH) HIV surveillance system and the DC Cohort study were matched to identify people living with HIV who were DC residents and had consented for the study by the end of 2016. Analysis was performed to identify differences between DC Cohort and noncohort participants by demographics and comorbid conditions. HIV disease stage, receipt of care, and viral suppression were evaluated. Adjusted logistic regression assessed correlates of health outcomes between the two groups.
RESULTS
There were 12,964 known people living with HIV in DC at the end of 2016, of which 40.1% were DC Cohort participants. Compared with nonparticipants, participants were less likely to be male (68.0% vs 74.9%, P<.001) but more likely to be black (82.3% vs 69.5%, P<.001) and have a heterosexual contact HIV transmission risk (30.3% vs 25.9%, P<.001). DC Cohort participants were also more likely to have ever been diagnosed with stage 3 HIV disease (59.6% vs 47.0%, P<.001), have a CD4 <200 cells/µL in 2017 (6.2% vs 4.6%, P<.001), be retained in any HIV care in 2017 (72.9% vs 59.4%, P<.001), and be virally suppressed in 2017. After adjusting for demographics, DC Cohort participants were significantly more likely to have received care in 2017 (adjusted odds ratio 1.8, 95% CI 1.70-2.00) and to have ever been virally suppressed (adjusted odds ratio 1.3, 95% CI 1.20-1.40).
CONCLUSIONS
These data have important implications when assessing the representativeness of patients enrolled in clinic-based cohorts compared with the DC-area general HIV population. As participants continue to enroll in the DC Cohort study, ongoing assessment of representativeness will be required.
背景
艾滋病毒队列研究已被用于评估健康结果，并为艾滋病毒感染者的护理和治疗提供信息。然而，队列参与者与他们所在地区的一般人群之间可能存在相似之处和差异。
目的
本分析的目的是比较参加和未参加华盛顿特区（DC）队列研究的艾滋病毒感染者，并评估参与者是否是特区艾滋病毒感染者的全市代表性样本。
方法
从 DC 健康（DCDOH）艾滋病毒监测系统和 DC 队列研究中获取数据，以确定到 2016 年底居住在 DC 且同意参与研究的艾滋病毒感染者。通过人口统计学和合并症来识别队列参与者和非队列参与者之间的差异。评估了艾滋病毒疾病阶段、获得护理和病毒抑制情况。采用调整后的逻辑回归评估两组之间健康结果的相关性。
结果
2016 年底，特区已知有 12964 名艾滋病毒感染者，其中 40.1%为 DC 队列参与者。与非参与者相比，参与者中男性的比例较低（68.0% vs 74.9%，P<.001），但黑人的比例较高（82.3% vs 69.5%，P<.001），异性性接触艾滋病毒传播风险较高（30.3% vs 25.9%，P<.001）。DC 队列参与者也更有可能在 2017 年被诊断为 3 期艾滋病毒疾病（59.6% vs 47.0%，P<.001），2017 年 CD4 细胞数<200 个/µL（6.2% vs 4.6%，P<.001），2017 年在任何艾滋病毒护理中均有保留（72.9% vs 59.4%，P<.001），并在 2017 年病毒得到抑制。调整人口统计学因素后，DC 队列参与者在 2017 年获得护理的可能性显著更高（调整后的优势比 1.8，95%置信区间 1.70-2.00），并且曾经病毒得到抑制的可能性也更高（调整后的优势比 1.3，95%置信区间 1.20-1.40）。
结论
在评估与特区一般艾滋病毒人群相比，诊所队列中纳入的患者的代表性时，这些数据具有重要意义。随着参与者继续参加 DC 队列研究，需要对代表性进行持续评估。
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