Centre for Microbiology Research, Kenya Medical Research Institute, PO Box 54840-00200, Nairobi, Kenya.
Centre for Microbiology Research, Kenya Medical Research Institute, PO Box 54840-00200, Nairobi, Kenya.
Int J Infect Dis. 2020 Aug;97:151-158. doi: 10.1016/j.ijid.2020.05.097. Epub 2020 Jun 2.
Limited data are available on the incidence and factors associated with viral rebound following viral suppression among HIV-infected individuals taking antiretroviral therapy (ART) in Kenya. Furthermore, the durability of viral suppression among HIV individuals taking ART is unknown. Information on incidence rates and factors associated with HIV viral load rebound and the durability of viral suppression (undetectable HIV copies in plasma) among HIV-infected individuals taking ART, will help improve the long-term management of HIV-infected individuals and explore approaches to long-term HIV remission or complete cure.
The objectives of this study were to investigate the incidence rates of viral rebound following viral suppression, factors associated with viral rebound, and the durability of viral suppression among HIV-infected individuals on ART from Kilifi, Meru, and Nakuru counties in Kenya.
This was a retrospective study involving 600 HIV-infected individuals taking combination ART (cART) and enrolled in comprehensive care centers (CCCs) at Malindi Sub-county Hospital, Nakuru Level 5 Hospital, and Meru Level 5 Hospital in Kenya. The medical files were inspected and medical history records abstracted for the selected participants. Participant laboratory data including HIV viral loads, types and history of ART, and treatment history of any opportunistic infections were abstracted using an abstraction checklist. Participants were grouped into those who achieved HIV viral suppression, with viral loads lower than the detection limit (LDL) (viral suppression), and those who experienced one or more detectable viral load measurements >40 copies/ml following the initial LDL (viral rebound). Durable viral suppression was defined as all viral load values at LDL over the 2-year period (2017-2019). Univariate and multivariate Poisson regression analyses were performed to assess the rates of viral rebound, as well as to investigate factors associated with it.
Out of 549 HIV-positive patients, 324/549 (59%) achieved HIV viral suppression (Meru 159/194 (82%), Nakuru 21/178 (12%), and Malindi 144/177 (81%)). The overall viral rebound rate was 41%, with site-specific viral rebound of 88.2%, 18.6%, and 18.0% in Nakuru, Malindi, and Meru, respectively. There was an overall rate of first viral rebound of 3.9 (95% confidence interval (CI) 6.9-14.4), 0.7 (95% CI 0.5-1.0), and 0.89 (95% CI 0.64-1.24) per 100 person-months in Nakuru, Malindi, and Meru, respectively. Good ART adherence (p = 0.0002), widow status (p = 0.0062), and World Health Organization (WHO) stage I (p = 0.0002) were associated with viral suppression, while poor ART adherence (p < 0.0001), WHO stage II (p = 0.0024), and duration on ART of 36 months (p = 0.0350) were associated with viral rebound.
The rate of viral suppression in patients on cART in the CCCs fell short of the WHO target. However, the study provides proof of evidence of undetectable viral load levels for more than 2 years, a sign that the United Nation's 2030 objective of controlling the risk of HIV transmission could be achieved.
在肯尼亚，接受抗逆转录病毒疗法（ART）的艾滋病毒感染者在病毒抑制后出现病毒反弹的发生率和相关因素的数据有限。此外，接受 ART 的艾滋病毒感染者的病毒抑制的持久性尚不清楚。有关艾滋病毒感染者在接受 ART 治疗后病毒载量反弹的发生率和相关因素，以及病毒抑制的持久性（血浆中无法检测到 HIV 拷贝）的信息，将有助于改善艾滋病毒感染者的长期管理，并探索长期 HIV 缓解或完全治愈的方法。
本研究的目的是调查肯尼亚基利菲、梅鲁和纳库鲁县接受 ART 的艾滋病毒感染者在病毒抑制后病毒反弹的发生率、相关因素，以及病毒抑制的持久性。
这是一项回顾性研究，涉及在肯尼亚马林迪县医院、纳库鲁 5 级医院和梅鲁 5 级医院综合护理中心接受联合 ART（cART）的 600 名艾滋病毒感染者。检查了他们的医疗档案，并为选定的参与者摘录了病史记录。使用摘录检查表摘录了参与者的实验室数据，包括 HIV 病毒载量、ART 的类型和历史，以及任何机会性感染的治疗历史。参与者被分为 HIV 病毒载量低于检测下限（LDL）的病毒抑制组（病毒抑制），以及在最初 LDL 后出现一次或多次可检测病毒载量>40 拷贝/ml 的病毒反弹组。持久的病毒抑制定义为在 2 年期间（2017-2019 年）所有 LDL 值的病毒载量均低于 LDL。进行了单变量和多变量泊松回归分析，以评估病毒反弹的发生率，并调查相关因素。
在 549 名 HIV 阳性患者中，324/549（59%）达到了 HIV 病毒抑制（梅鲁 159/194（82%）、纳库鲁 21/178（12%）和马林迪 144/177（81%））。总的病毒反弹率为 41%，在纳库鲁、马林迪和梅鲁的特定部位病毒反弹率分别为 88.2%、18.6%和 18.0%。纳库鲁、马林迪和梅鲁的首次病毒反弹率分别为每 100 人-月 3.9（95%置信区间（CI）为 6.9-14.4）、0.7（95%CI 为 0.5-1.0）和 0.89（95%CI 为 0.64-1.24）。良好的 ART 依从性（p = 0.0002）、寡妇身份（p = 0.0062）和世卫组织 I 期（p = 0.0002）与病毒抑制相关，而不良的 ART 依从性（p < 0.0001）、世卫组织 II 期（p = 0.0024）和 ART 治疗 36 个月（p = 0.0350）与病毒反弹相关。
在 CCC 接受 cART 的患者中，病毒抑制率低于世卫组织的目标。然而，该研究提供了 2 年以上无法检测到病毒载量水平的证据，这表明联合国控制 HIV 传播风险的 2030 年目标是可以实现的。
