在阿姆斯特丹，对男男性行为者实施目标性检测和立即启动急性人类免疫缺陷病毒感染治疗后，病毒抑制时间缩短。

Decreased Time to Viral Suppression After Implementation of Targeted Testing and Immediate Initiation of Treatment of Acute Human Immunodeficiency Virus Infection Among Men Who Have Sex With Men in Amsterdam.

机构信息

Department of Infectious Diseases, Public Health Service, Amsterdam, The Netherlands.

Division of Infectious Diseases, Department of Internal Medicine, Amsterdam Institute for Infection and Immunity, Amsterdam University Medical Center, University of Amsterdam, The Netherlands.

出版信息

Clin Infect Dis. 2021 Jun 1;72(11):1952-1960. doi: 10.1093/cid/ciaa505.

DOI:10.1093/cid/ciaa505

PMID:32369099

Abstract

BACKGROUND

Men who have sex with men (MSM) with acute human immunodeficiency virus (HIV) infection (AHI) are a key source of new infections. To curb transmission, we implemented a strategy for rapid AHI diagnosis and immediate initiation of combination antiretroviral therapy (cART) in Amsterdam MSM. We assessed its effectiveness in diagnosing AHI and decreasing the time to viral suppression.

METHODS

We included 63 278 HIV testing visits in 2008-2017, during which 1013 MSM were diagnosed. Standard of care (SOC) included HIV diagnosis confirmation in < 1 week and cART initiation in < 1 month. The AHI strategy comprised same-visit diagnosis confirmation and immediate cART. Time from diagnosis to viral suppression was assessed for 3 cART initiation periods: (1) 2008-2011: cART initiation if CD4 < 500 cells/μL (SOC); (2) January 2012-July 2015: cART initiation if CD4 < 500 cells/μL, or if AHI or early HIV infection (SOC); and (3a) August 2015-June 2017: universal cART initiation (SOC) or (3b) August 2015-June 2017 (the AHI strategy).

RESULTS

Before implementation of the AHI strategy, the proportion of AHI among HIV diagnoses was 0.6% (5/876); after implementation this was 11.0% (15/137). Median time (in days) to viral suppression during periods 1, 2, 3a, and 3b was 584 (interquartile range [IQR], 267-1065), 230 (IQR, 132-480), 95 (IQR, 63-136), and 55 (IQR, 31-72), respectively (P < .001).

CONCLUSIONS

Implementing the AHI strategy was successful in diagnosing AHI and significantly decreasing the time between HIV diagnosis and viral suppression.

摘要

背景

男男性行为者（MSM）中急性人类免疫缺陷病毒（HIV）感染（AHI）是新感染的主要来源。为了遏制传播，我们在阿姆斯特丹 MSM 中实施了一项快速 AHI 诊断和立即开始联合抗逆转录病毒治疗（cART）的策略。我们评估了该策略在诊断 AHI 和缩短病毒抑制时间方面的效果。

方法

我们纳入了 2008-2017 年期间的 63278 次 HIV 检测就诊，其中 1013 例 MSM 被诊断为 AHI。标准护理（SOC）包括在<1 周内确认 HIV 诊断和在<1 个月内开始 cART。AHI 策略包括在就诊时同时进行诊断确认和立即开始 cART。我们评估了在三个 cART 起始时期的从诊断到病毒抑制的时间：（1）2008-2011 年：如果 CD4<500 个细胞/μL（SOC），则开始 cART；（2）2012 年 1 月-2015 年 7 月：如果 CD4<500 个细胞/μL，或 AHI 或早期 HIV 感染（SOC），则开始 cART；（3a）2015 年 8 月-2017 年 6 月：普遍开始 cART（SOC）或（3b）2015 年 8 月-2017 年 6 月（AHI 策略）。

结果

在实施 AHI 策略之前，HIV 诊断中 AHI 的比例为 0.6%（5/876）；实施后这一比例为 11.0%（15/137）。在时期 1、2、3a 和 3b 中，病毒抑制的中位数时间（天）分别为 584（四分位距[IQR]，267-1065）、230（IQR，132-480）、95（IQR，63-136）和 55（IQR，31-72）（P<0.001）。