印度孟买一个公立艾滋病治疗中心常规进行病毒载量监测和增强式依从性咨询。
Routine viral load monitoring and enhanced adherence counselling at a public ART centre in Mumbai, India.
机构信息
Médecins Sans Frontières, Mumbai, India.
Mumbai Districts AIDS Control Society, Mumbai, India.
出版信息
PLoS One. 2020 May 5;15(5):e0232576. doi: 10.1371/journal.pone.0232576. eCollection 2020.
BACKGROUND
Routine viral-load (VL) measurements along with enhanced adherence counselling (EAC) are recommended to achieve virological suppression among people living with HIV/AIDS (PLHA) on anti-retroviral therapy (ART). The Mumbai Districts AIDS Control Society along with Médecins Sans Frontières has provided routine VL measurements and EAC to PLHA on ART at King Edward Memorial (KEM) hospital, Mumbai since October-2016. This study aims to describe the initial VL results and impact of EAC on viral suppression and factors associated with initial viral non-suppression among patients with an initial detectable VL, in a cohort of patients tested between October-2016 and September-2018.
METHODS
This is a descriptive study of PLHA on ART who received VL testing and EAC during October-2016 to September-2018. Log-binomial regression was used to identify factors associated with a high VL.
RESULTS
Among 3849 PLHA who underwent VL testing, 1603(42%) were female and median age was 42 years (IQR:35-48). Majority were referred for routine testing (3432(89%)) and clinical/immunological failure (233(6%)). Overall, 3402(88%) PLHA had suppressed VL at initial testing. Among 3432 tested for routine monitoring, 3141(92%) had VL suppressed. Of 291 with VL>1000c/ml, 253(87%) received EAC and after repeat VL, 70(28%) had VL<1000c/ml. Among 233 referred for clinical/immunological failure, 122(52%) had VL>1000c/ml and 109 have been switched to second-line ART. CD4 count<500 (aOR-5.0[95%CI 3.8-6.5]), on ART for<5 years (aOR-1.5[1.1-2.0]) and age<15 years (aOR-5.2[3.0-8.9]) were associated with an initial VL>1000c/ml. Factors associated with follow-up VL suppression included EAC (p<0.05) and being on second-line ART (p<0.05).
CONCLUSION
Results from a routine VL program in public sector in India were encouraging and in line with UNAIDS 90-90-90 targets. Routine VL monitoring along with EAC resulted in early switch to alternative optimised regimens while also preventing unnecessary switches. Along with the vital scale up of routine VL monitoring, implementation of enhanced adherence strategies for patients with detectable viral load should be ensured.
背景
建议在接受抗逆转录病毒疗法（ART）的艾滋病毒/艾滋病（PLHA）人群中进行常规病毒载量（VL）测量和增强型依从性咨询（EAC），以实现病毒学抑制。自 2016 年 10 月以来，孟买地区艾滋病控制协会与无国界医生组织一起，在孟买的 KEM 医院为接受 ART 的 PLHA 提供常规 VL 测量和 EAC。本研究旨在描述接受 VL 检测和 EAC 的患者的初始 VL 结果，并探讨其对病毒抑制的影响，以及与初始 VL 可检测的患者中初始病毒未抑制相关的因素，该队列的患者在 2016 年 10 月至 2018 年 9 月期间接受了检测。
方法
这是一项对接受 VL 检测和 EAC 的接受 ART 的 PLHA 的描述性研究，时间为 2016 年 10 月至 2018 年 9 月。使用对数二项式回归来确定与高 VL 相关的因素。
结果
在接受 VL 检测的 3849 名 PLHA 中，有 1603 名（42%）为女性，中位年龄为 42 岁（IQR：35-48）。大多数患者因常规检测（3432 例（89%））和临床/免疫失败（233 例（6%））而接受检测。总体而言，3402 名 PLHA 在初始检测时 VL 得到抑制。在接受常规监测的 3432 名患者中，有 3141 名（92%）VL 得到抑制。在 291 名 VL>1000c/ml 的患者中，有 253 名（87%）接受了 EAC，在重复 VL 后，有 70 名（28%）VL<1000c/ml。在因临床/免疫失败而接受检测的 233 名患者中，有 122 名（52%）VL>1000c/ml，其中 109 名已转为二线 ART。CD4 计数<500（aOR-5.0[95%CI 3.8-6.5]）、接受 ART<5 年（aOR-1.5[1.1-2.0]）和年龄<15 岁（aOR-5.2[3.0-8.9]）与初始 VL>1000c/ml 相关。与随访 VL 抑制相关的因素包括 EAC（p<0.05）和使用二线 ART（p<0.05）。
结论
印度公共部门常规 VL 计划的结果令人鼓舞，符合 UNAIDS 90-90-90 目标。常规 VL 监测和 EAC 相结合，可早期转为替代优化方案，同时避免不必要的转换。除了大规模扩大常规 VL 监测外，还应确保为可检测到病毒载量的患者实施增强型依从性策略。
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