Nasomsong Worapong, Phokaphol Kwonchit, Changpradub Dhitiwat
Division of Infectious Diseases, Department of Internal Medicine, Phramongkutklao Hospital, Bangkok, Thailand.
HIV AIDS (Auckl). 2021 Mar 4;13:261-269. doi: 10.2147/HIV.S295512. eCollection 2021.
HIV treatment involves antiretroviral therapy (ART) endeavoring to suppress viral load to an undetectable level. Virologic failure occurs when ART fails to suppress and sustain an individual's viral load to less than 200 copies/mL after 6 months of therapy. In Thailand, the data among first-line antiretroviral regimen failure and determinants remains limited, especially in urban HIV clinics. We aimed to demonstrate factors of first-line antiretroviral regimen failures in an urban HIV/AIDS clinic at Phramongkutklao Hospital.
A nested case control 1:4 study was conducted. Data were collected from the electronic patient database among naïve people living with HIV/AIDS (PLWHA), aged ≥18 years and receiving ART continuously for at least 2 years at Phramongkutklao Hospital from 1 January 2000 to 31 December 2019. Multiple logistic regression was used to identify the determinants of virologic failure. Adjusted HRs (AHRs) with 95% CIs were used to declare statistical significance.
Of 200 PLWHA included in the study, 40 participants experienced HIV virologic failure. The median time after starting ART to virologic failure was 24 months (IQR 7-96.0). Univariate and multivariate analysis showed significant factors affecting first-line antiretroviral regimen failure included being female (37.5 vs 26.88%, adjusted odds ratio 5.08 [1.05-24.6, p-value 0.043], age ≤40 yr. (62.5 vs 49.6%, adjusted odds ratio 4.59 [1.47-14.37], p-value 0.009), CD4+count ≤200 cell/µL (77.5 vs 52.5%, adjusted odds ratio 4.83 [1.28-18.9], p value 0.02), tuberculosis (42.5 vs 7.5%, adjusted odds ratio 8.66 [2.37-31.56], p value <0.001) and initiation of ART at CD4+ count <350 cell/µL (72.5 vs 48.13%, adjusted odds ratio 31.36 [6.51-151.22], p value <0.001). Estimated prevalence of virologic failure in Phramongkutklao Hospital was 5.34%.
Our study revealed factors favoring virologic failure included being female, younger age, CD4+ count <200 cells/µL, tuberculosis and initiation of ART at CD4+ count <350 cell/µL. Multidisciplinary HIV comprehensive care teams should encourage patient adherence and support patients along HIV continuum of care to prevent virologic failure and drug resistance, especially among patients initiating ART at low CD4+ count and tuberculosis co-infection.
HIV治疗包括抗逆转录病毒疗法（ART），旨在将病毒载量抑制到无法检测的水平。当ART在治疗6个月后未能将个体的病毒载量抑制并维持在低于200拷贝/毫升时，就会发生病毒学失败。在泰国，一线抗逆转录病毒治疗方案失败及其决定因素的数据仍然有限，尤其是在城市HIV诊所。我们旨在阐明佛统皇家医院城市HIV/AIDS诊所一线抗逆转录病毒治疗方案失败的因素。
进行了一项1:4巢式病例对照研究。数据从2000年1月1日至2019年12月31日在佛统皇家医院年龄≥18岁且持续接受ART至少2年的初治HIV/AIDS患者（PLWHA）的电子患者数据库中收集。采用多因素逻辑回归来确定病毒学失败的决定因素。使用调整后的风险比（AHRs）及95%置信区间（CIs）来判定统计学显著性。
该研究纳入的200例PLWHA中，40例出现HIV病毒学失败。开始ART至病毒学失败的中位时间为24个月（四分位间距7 - 96.0）。单因素和多因素分析显示，影响一线抗逆转录病毒治疗方案失败的显著因素包括女性（37.5%对26.88%，调整后的优势比5.08 [1.05 - 24.6，p值0.043]）、年龄≤40岁（62.5%对49.6%，调整后的优势比4.59 [1.47 - 14.37]，p值0.009）、CD4 +细胞计数≤200个/微升（77.5%对52.5%，调整后的优势比4.83 [1.28 - 18.9]，p值0.02）、结核病（42.5%对7.5%，调整后的优势比8.66 [2.37 - 31.56]，p值<0.001）以及在CD4 +细胞计数<350个/微升时开始ART（72.5%对48.13%，调整后的优势比31.36 [6.51 - 151.22]，p值<0.001）。佛统皇家医院病毒学失败的估计患病率为5.34%。
我们的研究表明，有利于病毒学失败的因素包括女性、年龄较小、CD4 +细胞计数<200个/微升、结核病以及在CD4 +细胞计数<350个/微升时开始ART。多学科HIV综合护理团队应鼓励患者坚持治疗，并在HIV连续护理过程中为患者提供支持，以预防病毒学失败和耐药，特别是在CD4 +细胞计数较低时开始ART的患者以及合并结核病感染的患者中。
