公共卫生设施中未受抑制的病毒载量水平：埃塞俄比亚西南部接受抗逆转录病毒治疗的成年患者的非病毒学预测因素
Unsuppressed Viral Load Level in Public Health Facilities: Nonvirological Predictors among Adult Antiretroviral Therapy Users in Southwestern Ethiopia.
作者信息
Waju Birhanu, Dube Lamessa, Ahmed Muktar, Assefa Semira Shimeles
机构信息
ICAP Ethiopia HIV Prevention, Care and Treatment Program, Addis Ababa, Ethiopia.
Jimma University, Department of Epidemiology, Jimma, Ethiopia.
出版信息
HIV AIDS (Auckl). 2021 May 14;13:513-526. doi: 10.2147/HIV.S304653. eCollection 2021.
BACKGROUND
Unsuppressed viral load in patients on antiretroviral (ARV) therapy occurs when treatment fails to suppress a patient's viral load, and is associated with decreased survival and increased HIV transmission. Identifying the level of unsuppressed viral load with its associated factors has benefits in controlling transmission and reducing burden. Therefore, this study aimed to assess unsuppressed viral load (>1,000 copies/mL) and associated factors among HIV patients taking first-line antiretroviral treatment at public health facilities in Jimma, Ethiopia.
METHODS
A facility-based cross-sectional study was conducted on 669 patients on first-line ARV therapy (at least 6 months) in public health facilities in Jimma. Sociodemographic, treatment, clinical, immunological, and viral load data were extracted from medical records, entered into EpiData 3.1, and analyzed with SPSS 20. Multivariate logistic regression analysis was performed to identify factors independently associated with viral nonsuppression, considering a 95% CI with <0.05 statistically significant.
RESULTS
Among the participants, 258 (38.6%) were aged 25-34 years. Median age was 35 years. Prevalence of unsuppressed viral load was 20.3%. Risk of unsuppressed viral loads was 91% lower among ARV therapy patients who had been taking ARV therapy <2 years (AOR 0.09, 95% CI 0.01-0.83), lower baseline BMI (AOR 4.44, 95% CI 1.56-12.64), lower baseline CD4 (AOR 2.76, 95% CI 1.45-5.29), poor adherence to ARV therapy medication (AOR 3.19, 95% CI 1.29-7.89), and immunological failure (AOR 4.26, 95% CI 2.56-7.09) were the independent predictors of unsuppressed viral load.
CONCLUSION
This study revealed that there is a high level of virological failure among adult HIV patients, and confirms the need to develop close follow-up strategies of targeted interventions for patients in care who are at high risk of unsuppressed viral load.
背景
接受抗逆转录病毒（ARV）治疗的患者中，若治疗未能抑制患者的病毒载量，则会出现病毒载量未被抑制的情况，这与生存率降低和HIV传播增加有关。确定未被抑制的病毒载量水平及其相关因素有助于控制传播并减轻负担。因此，本研究旨在评估埃塞俄比亚吉马市公共卫生机构中接受一线抗逆转录病毒治疗的HIV患者中未被抑制的病毒载量（>1000拷贝/毫升）及其相关因素。
方法
在吉马市的公共卫生机构中，对669例接受一线ARV治疗（至少6个月）的患者进行了一项基于机构的横断面研究。从医疗记录中提取社会人口统计学、治疗、临床、免疫学和病毒载量数据，录入EpiData 3.1，并使用SPSS 20进行分析。进行多变量逻辑回归分析，以确定与病毒未被抑制独立相关的因素，将95%置信区间且P<0.05视为具有统计学显著性。
结果
参与者中，258例（38.6%）年龄在25 - 34岁之间。中位年龄为35岁。未被抑制的病毒载量患病率为20.3%。接受ARV治疗<2年的ARV治疗患者中，病毒载量未被抑制的风险降低了91%（调整后比值比[AOR]为0.09，95%置信区间为0.01 - 0.83），基线体重指数较低（AOR为4.44，95%置信区间为1.56 - 12.64），基线CD4较低（AOR为2.76，95%置信区间为1.45 - 5.29），对ARV治疗药物依从性差（AOR为3.19，95%置信区间为1.29 - 7.89）以及免疫失败（AOR为4.26，95%置信区间为2.56 - 7.09）是病毒载量未被抑制的独立预测因素。
结论
本研究表明成年HIV患者中存在较高水平的病毒学失败情况，并证实有必要为病毒载量未被抑制风险较高的接受治疗患者制定针对性干预的密切随访策略。
Zotero 插件