Clinical Infection Medicine, Department of Translational Medicine, Lund University, Malmö, Sweden.
Centre for Geographic Medicine Research, Kenya Medical Research Institute (KEMRI), Kilifi, Kenya.
PLoS One. 2020 Dec 15;15(12):e0244066. doi: 10.1371/journal.pone.0244066. eCollection 2020.
The potential impact of socio-economic condition on virological suppression during antiretroviral treatment (ART) in sub-Saharan Africa is largely unknown. In this case-control study, we compared socio-economic factors among Ethiopian ART recipients with lack of virological suppression to those with undetectable viral load (VL).
Cases (VL>1000 copies/ml) and controls (VL<150 copies/ml) aged ≥15years, with ART for >6 months and with available VL results within the last 3 months, were identified from registries at public ART clinics in Central Ethiopia. Questionnaire-based interviews on socio-economic characteristics, health condition and transmission risk behavior were conducted. Univariate variables associated with VL>1000 copies/ml (p<0.25) were added to a multivariable logistic regression model.
Among 307 participants (155 cases, 152 controls), 61.2% were female, and the median age was 38 years (IQR 32-46). Median HIV-RNA load among cases was 6,904 copies/ml (IQR 2,843-26,789). Compared to controls, cases were younger (median 36 vs. 39 years; p = 0.004), more likely to be male (46.5% vs. 30.9%; p = 0.005) and had lower pre-ART CD4 cell counts (170 vs. 220 cells/μl; p = 0.009). In multivariable analysis of urban residents (94.8%), VL>1000 copies/ml was associated with lower relative wealth (adjusted odds ratio [aOR] 2.98; 95% CI 1.49-5.94; p = 0.016), geographic work mobility (aOR 6.27, 95% CI 1.82-21.6; p = 0.016), younger age (aOR 0.94 [year], 95% CI 0.91-0.98; p = 0.011), longer duration of ART (aOR 1.19 [year], 95% CI 1.07-1.33; p = 0.020), and suboptimal (aOR 3.83, 95% CI 1.33-10.2; p = 0.048) or poor self-perceived wellbeing (aOR 9.75, 95% CI 2.85-33.4; p = 0.012), after correction for multiple comparisons. High-risk sexual behavior and substance use was not associated with lack of virological suppression.
Geographic work mobility and lower relative wealth were associated with lack of virological suppression among Ethiopian ART recipients in this predominantly urban population. These characteristics indicate increased risk of treatment failure and the need for targeted interventions for persons with these risk factors.
在撒哈拉以南非洲，社会经济状况对接受抗逆转录病毒治疗（ART）的病毒学抑制的潜在影响在很大程度上尚不清楚。在这项病例对照研究中，我们比较了埃塞俄比亚接受 ART 治疗且病毒载量未被抑制（VL>1000 拷贝/ml）的患者与病毒载量不可检测（VL<150 拷贝/ml）的患者的社会经济因素。
从埃塞俄比亚中部公立 ART 诊所的登记处确定了年龄≥15 岁、ART 治疗时间>6 个月且在过去 3 个月内有可用 VL 结果的病例（VL>1000 拷贝/ml）和对照（VL<150 拷贝/ml）。对社会经济特征、健康状况和传播风险行为进行了基于问卷的访谈。将与 VL>1000 拷贝/ml 相关的单变量变量（p<0.25）添加到多变量逻辑回归模型中。
在 307 名参与者（155 例病例，152 例对照）中，61.2%为女性，中位年龄为 38 岁（IQR 32-46）。病例的中位 HIV-RNA 载量为 6904 拷贝/ml（IQR 2843-26789）。与对照组相比，病例组更年轻（中位数 36 岁 vs. 39 岁；p = 0.004），更可能为男性（46.5% vs. 30.9%；p = 0.005），且 ART 前的 CD4 细胞计数更低（170 与 220 个/μl；p = 0.009）。在对城市居民（94.8%）的多变量分析中，VL>1000 拷贝/ml 与相对较低的财富（调整后的优势比 [aOR] 2.98；95%CI 1.49-5.94；p = 0.016）、地域工作流动性（aOR 6.27，95%CI 1.82-21.6；p = 0.016）、年龄较小（aOR 0.94 [岁]，95%CI 0.91-0.98；p = 0.011）、ART 持续时间较长（aOR 1.19 [年]，95%CI 1.07-1.33；p = 0.020）以及治疗效果不理想（aOR 3.83，95%CI 1.33-10.2；p = 0.048）或自我感知健康状况不佳（aOR 9.75，95%CI 2.85-33.4；p = 0.012）有关，校正多重比较后差异仍有统计学意义。高风险性行为和物质使用与病毒学抑制失败无关。
在这个主要是城市人口中，地域工作流动性和相对较低的财富与埃塞俄比亚接受 ART 治疗的患者的病毒学抑制失败有关。这些特征表明治疗失败的风险增加，需要针对具有这些风险因素的人群进行有针对性的干预。
