在性健康诊所为新诊断出的 HIV 患者启动抗逆转录病毒治疗可大大提高病毒抑制的及时性。

Initiating antiretroviral treatment for newly diagnosed HIV patients in sexual health clinics greatly improves timeliness of viral suppression.

机构信息

New York City Department of Health and Mental Hygiene, Bureau of Sexually Transmitted Infections, New York, NY.

Retired (formerly with New York City Department of Health and Mental Hygiene and Centers for Disease Control and Prevention, Division of STD Prevention, Atlanta, GA, USA).

出版信息

AIDS. 2021 Sep 1;35(11):1805-1812. doi: 10.1097/QAD.0000000000002937.

DOI:10.1097/QAD.0000000000002937

PMID:33973874

Abstract

OBJECTIVE

The 'JumpstART' program in New York City (NYC) public Sexual Health Clinics (SHC) provides patients newly diagnosed with human immunodeficiency virus (HIV) with antiretroviral medication (ART) (1-month supply) on day of diagnosis and active linkage to HIV care (LTC). We examined viral suppression (VS) among patients who did and did not receive JumpstART services.

DESIGN

Retrospective cohort.

METHODS

Among newly diagnosed SHC patients (23 November 2016-30 September 2018) who were matched to the NYC HIV surveillance registry to obtain HIV laboratory test results through 30 June 2019, we compared 230 JumpstART and 73 non-JumpstART patients regarding timely LTC (≤30 days), probability of VS (viral load < 200 copies/ml) by 3 months post-diagnosis, and time to and factors associated with achieving VS within the follow-up period.

RESULTS

Of 303 patients, 76% (230/303) were JumpstART and the remaining were non-JumpstART patients; 36 (11%) had acute HIV infections. LTC ≤30 days was observed for 63% of JumpstART and 73% of non-JumpstART patients. By 3 months post-diagnosis, 83% of JumpstART versus 45% of non-JumpstART patients achieved VS (log-rank, P < .0001). Median times to VS among virally suppressed JumpstART and non-JumpstART patients were 31 (interquartile range [IQR]: 24-51) and 95 days (IQR: 52-153), respectively. For groups with and without timely LTC, JumpstART was associated with viral suppression within 3 months post-diagnosis, after adjusting for age and baseline viral load.

CONCLUSIONS

Prompt ART initiation among SHC patients, some with acute HIV infections, resulted in markedly shortened intervals to VS. Immediate ART provision and active LTC can be key contributors to improved HIV treatment outcomes and the treatment-as-prevention paradigm, with potential for downstream, population-level benefit.

摘要

目的

纽约市（NYC）公共性健康诊所（SHC）的“JumpstART”项目为新诊断出感染人类免疫缺陷病毒（HIV）的患者在诊断当天提供抗逆转录病毒药物（ART）（1 个月的供应量）和积极的 HIV 护理（LTC）衔接服务。我们调查了接受和未接受 JumpstART 服务的患者中病毒抑制（VS）的情况。

设计

回顾性队列研究。

方法

在 2016 年 11 月 23 日至 2018 年 9 月 30 日期间新诊断为 SHC 的患者（与 NYC HIV 监测登记处相匹配，以在 2019 年 6 月 30 日之前获得 HIV 实验室检测结果）中，我们比较了 230 名 JumpstART 和 73 名非 JumpstART 患者，比较了他们是否及时进行 LTC（≤30 天）、诊断后 3 个月时 VS（病毒载量＜200 拷贝/ml）的概率，以及在随访期间实现 VS 的时间和相关因素。

结果

在 303 名患者中，76%（230/303）为 JumpstART，其余为非 JumpstART 患者；36 名（11%）为急性 HIV 感染者。63%的 JumpstART 和 73%的非 JumpstART 患者在 30 天内进行了 LTC。诊断后 3 个月时，83%的 JumpstART 患者与 45%的非 JumpstART 患者达到 VS（对数秩检验，P＜0.0001）。病毒抑制的 JumpstART 和非 JumpstART 患者的中位 VS 时间分别为 31 天（四分位间距 [IQR]：24-51）和 95 天（IQR：52-153）。对于及时进行 LTC 和未及时进行 LTC 的两组患者，JumpstART 与诊断后 3 个月内的病毒抑制相关，在调整年龄和基线病毒载量后仍有统计学意义。