在高负担环境中同时存在晚期 HIV 疾病和病毒载量抑制：来自 2015-6 年 ZIMPHIA 调查的结果。
Concurrent advanced HIV disease and viral load suppression in a high-burden setting: Findings from the 2015-6 ZIMPHIA survey.
机构信息
Division of Global HIV and Tuberculosis, U.S. Centers for Disease Control and Prevention, Bluffhill, Harare, Zimbabwe.
PHI/CDC Global Epidemiology Fellowship, U.S. Centers for Disease Control and Prevention, Bluffhill, Harare, Zimbabwe.
出版信息
PLoS One. 2020 Jun 25;15(6):e0230205. doi: 10.1371/journal.pone.0230205. eCollection 2020.
BACKGROUND
As Zimbabwe approaches epidemic control of HIV, programs now prioritize viral load over CD4 monitoring, making it difficult to identify persons living with HIV (PLHIV) suffering from advanced disease (AD). We present an analysis of cross-sectional ZIMPHIA data, highlighting PLHIV with AD and concurrent viral load suppression (VLS).
METHODS
ZIMPHIA collected blood specimens for HIV testing from 22,501 consenting adults (ages 15 years and older); 3,466 PLHIV had CD4 and VL results. Household HIV testing used the national serial algorithm, and those testing positive then received point-of-care CD4 enumeration with subsequent VL testing. We used logistic regression analysis to explore factors associated with concurrent AD and VLS (<1000 copies/mL). All analyses were weighted to account for complex survey design.
RESULTS
Of the 3,466 PLHIV in the survey with CD4 and VL results, 17% were found to have AD (CD4<200cells/mm3). Of all AD patients, 30% had VLS. Concurrent AD and VLS was associated with male sex (aOR 2.45 95%CI 1.61-3.72), older age (35-49 years [aOR 2.46 95%CI 1.03-5.91] and 50+ years [aOR 4.82 95%CI 2.02-11.46] vs 15-24 years), and ART duration (<6 months [aOR 0.46 95%CI 0.29-0.76] and 6-24 months [aOR 2.07 95%CI 1.35-3.17] vs more than 2 years). The relationship between sex and AD is driven by age with significant associations among men aged 25-34, (aOR 3.37 95%CI 1.35-8.41), 35-49 (aOR 5.13 95%CI 2.16-12.18), and 50+ (aOR 12.56 95%CI 4.82-32.72) versus men aged 15-24.
CONCLUSIONS
The percentage of PLHIV with AD and VLS illustrates the conundrum of decreased support for CD4 monitoring, as these patients may not receive appropriate clinical services for advanced HIV disease. In high-prevalence settings such as Zimbabwe, CD4 monitoring support warrants further consideration to differentiate care appropriately for the most vulnerable PLHIV. Males may need to be prioritized, given their over-representation in this sub-population.
背景
随着津巴布韦接近艾滋病毒流行控制，目前的项目将病毒载量置于 CD4 监测之上，这使得难以识别患有晚期疾病 (AD) 的艾滋病毒感染者 (PLHIV)。我们展示了对 ZIMPHIA 数据的横断面分析，重点介绍了同时患有 AD 和病毒载量抑制 (VLS) 的 PLHIV。
方法
ZIMPHIA 从 22,501 名同意的成年人（年龄在 15 岁及以上）中采集了血液样本进行 HIV 检测；3466 名 PLHIV 有 CD4 和 VL 结果。家庭 HIV 检测采用国家串联算法，检测结果呈阳性的人随后接受即时 CD4 计数，并随后进行 VL 检测。我们使用逻辑回归分析探讨了与同时患有 AD 和 VLS（<1000 拷贝/ml）相关的因素。所有分析均进行了加权，以考虑到复杂的调查设计。
结果
在接受 CD4 和 VL 检测的 3466 名 PLHIV 中，17%的人被发现患有 AD（CD4<200 个细胞/mm3）。所有 AD 患者中，30%的人有 VLS。同时患有 AD 和 VLS 与男性（优势比 2.45，95%置信区间 1.61-3.72）、年龄较大（35-49 岁 [优势比 2.46，95%置信区间 1.03-5.91] 和 50 岁以上 [优势比 4.82，95%置信区间 2.02-11.46] 与 15-24 岁）和 ART 持续时间（<6 个月 [优势比 0.46，95%置信区间 0.29-0.76] 和 6-24 个月 [优势比 2.07，95%置信区间 1.35-3.17] 与超过 2 年）有关。性别的与 AD 的关系是由年龄驱动的，在 25-34 岁、35-49 岁和 50 岁及以上的男性中（优势比 3.37，95%置信区间 1.35-8.41）、（优势比 5.13，95%置信区间 2.16-12.18）和 50 岁以上（优势比 12.56，95%置信区间 4.82-32.72）与 15-24 岁的男性有显著关联。
结论
患有 AD 和 VLS 的 PLHIV 比例说明了 CD4 监测支持减少的困境，因为这些患者可能无法获得晚期 HIV 疾病的适当临床服务。在津巴布韦等高流行地区，CD4 监测支持值得进一步考虑，以便为最脆弱的 PLHIV 提供适当的护理。鉴于男性在这一亚人群中的比例过高，可能需要优先考虑男性。
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