一切都很重要——一种使用 HIV 护理连续体的纵向数据来确定艾滋病毒感染者病毒抑制情况的方法——两项大型、德国、多中心真实队列研究 20 多年（1999-2018 年）的结果。
Everything counts - a method to determine viral suppression among people living with HIV using longitudinal data for the HIV care continuum - results of two large, German, multi-center real-life cohort studies over 20 years (1999-2018).
机构信息
Department of Infectious Disease Epidemiology, Robert Koch Institute, Berlin, Germany.
Institute of Public Health, Charité - Universitätsmedizin Berlin, Berlin, Germany.
出版信息
BMC Public Health. 2021 Jan 22;21(1):200. doi: 10.1186/s12889-020-10088-7.
BACKGROUND
The aim of this study was to develop a standardized method to reconstruct persons' individual viral load (VL) courses to determine viral suppression and duration of viremia for the HIV care continuum in Germany using longitudinal cohort data.
METHODS
We analyzed data from two large, multi-center German cohort studies under the direction of the Robert Koch Institute. We included data from 1999 to 2018 of all diagnosed people and of people who initiated antiretroviral treatment (ART). We developed a model generating virtual VL values and an individual VL course corresponding to real VL measurements with a maximum distance of 180 days, considering ART status and VL dynamics. If the distance between VL measurements was > 180 days, the time between was defined as gap time. Additionally, we considered blips, which we defined as a single detectable VL < 1000 copies/ml within 180 days.
RESULTS
A total of 22,120 people (164,691 person-years, PY) after ART initiation were included in the analyses. The proportion of people with viral suppression (VL < 50 copies/ml) increased from 34% in 1999 to 93% in 2018. The proportion of people with VL < 200 copies/ml increased from 47% in 1999 to 96% in 2018. The proportion of people with viremia > 1000 copies/ml decreased from 37% in 1999 to 3% in 2018. The proportion of people with gap time fluctuated and ranged between 18 and 28%. An analysis of the first VL after gap time showed that 90% showed viral suppression, 5% VL between 50- < 1000 copies/ml and 5% VL > 1000 copies/ml.
CONCLUSION
We provide a method for estimating viral suppression and duration of viremia using longitudinal VL data. We observed a continuous and remarkable increase of viral suppression. Furthermore, a notable proportion of those with viremia showed low-level viremia and were therefore unlikely to transmit HIV. Individual health risks and HIV drug resistance among those with low-level viremia are problematic, and viral suppression remains the goal. In 2018, 93 and 96% of people after ART initiation showed VL < 50 copies/ml and VL < 200 copies/ml, respectively. Therefore, using the threshold of VL < 200 copies/ml, Germany reached the UNAIDS 95 target of viral suppression since 2017.
背景
本研究旨在开发一种标准化方法，以重建个人的病毒载量（VL）曲线，从而确定德国艾滋病毒护理连续体中的病毒抑制和病毒血症持续时间，该方法使用纵向队列数据。
方法
我们分析了罗伯特·科赫研究所指导下的两项大型、多中心德国队列研究的数据。我们纳入了从 1999 年到 2018 年所有诊断患者和开始抗逆转录病毒治疗（ART）的患者的数据。我们开发了一种模型，通过考虑 ART 状态和 VL 动态，生成虚拟 VL 值和与真实 VL 测量值对应的个体 VL 曲线，最大距离为 180 天。如果 VL 测量值之间的距离> 180 天，则定义该时间段为间隔时间。此外，我们还考虑了 VL 低于 1000 拷贝/ml 的单个可检测 VL 作为 blips，其在 180 天内出现。
结果
在开始 ART 后，共有 22120 人（164691 人年）纳入分析。VL < 50 拷贝/ml 的患者比例从 1999 年的 34%增加到 2018 年的 93%。VL < 200 拷贝/ml 的患者比例从 1999 年的 47%增加到 2018 年的 96%。VL > 1000 拷贝/ml 的患者比例从 1999 年的 37%下降到 2018 年的 3%。间隔时间的患者比例波动在 18%至 28%之间。对间隔时间后的首次 VL 分析表明，90%的患者表现出病毒抑制，5%的患者 VL 为 50-<1000 拷贝/ml，5%的患者 VL > 1000 拷贝/ml。
结论
我们提供了一种使用纵向 VL 数据估计病毒抑制和病毒血症持续时间的方法。我们观察到病毒抑制的持续显著增加。此外，相当一部分病毒血症患者的 VL 水平较低，因此不太可能传播 HIV。VL 水平较低的患者存在个体健康风险和 HIV 耐药性问题，病毒抑制仍然是目标。2018 年，开始 ART 后分别有 93%和 96%的患者的 VL < 50 拷贝/ml 和 VL < 200 拷贝/ml。因此，自 2017 年以来，德国使用 VL < 200 拷贝/ml 的阈值达到了联合国艾滋病规划署 95%的病毒抑制目标。
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