Satyanarayana Satyanand, Rogers Brooke G, Bainter Sierra A, Christopoulos Katerina A, Fredericksen Rob J, Mathews William C, Moore Richard D, Mugavero Michael J, Napravnik Sonia, Carrico Adam W, Mimiaga Matthew J, Mayer Kenneth H, Crane Heidi M, Safren Steven A
Department of Psychology, University of Miami, Coral Gables, Florida, USA.
Warren Alpert Medical School of Brown University, Providence, Rhode Island, USA.
AIDS Patient Care STDS. 2021 Jun;35(6):220-230. doi: 10.1089/apc.2021.0004.
Psychosocial syndemic conditions have received more attention regarding their deleterious effects on HIV acquisition risk than for their potential impact on HIV treatment and viral suppression. To examine syndemic conditions' impact on the HIV care continuum, we analyzed data collected from people living with HIV ( = 14,261) receiving care through The Centers for AIDS Research Network of Integrated Clinical Systems at seven sites from 2007 to 2017 who provided patient-reported outcomes ∼4-6 months apart. Syndemic condition count (depression, anxiety, substance use, and hazardous drinking), sexual risk group, and time in care were modeled to predict antiretroviral therapy (ART) adherence and viral suppression (HIV RNA <400 copies/mL) using multilevel logistic regression. Comparing patients with each other, odds of ART adherence were 61.6% lower per between-patient syndemic condition [adjusted odds ratio (AOR) = 0.384; 95% confidence interval (CI), 0.362-0.408]; comparing patients with themselves, odds of ART adherence were 36.4% lower per within-patient syndemic condition (AOR = 0.636 95% CI, 0.606-0.667). Odds of viral suppression were 29.3% lower per between-patient syndemic condition (AOR = 0.707; 95% CI, 0.644-0.778) and 27.7% lower per within-patient syndemic condition (AOR = 0.723; 95% CI, 0.671-0.780). Controlling for the effects of adherence (AOR = 5.522; 95% CI, 4.67-6.53), each additional clinic visit was associated with 1.296 times higher odds of viral suppression (AOR = 1.296; 95% CI, 1.22-1.38), but syndemic conditions were not significant. Deploying effective interventions within clinics to identify and treat syndemic conditions and bolster ART adherence and continued engagement in care can help control the HIV epidemic, even within academic medical settings in the era of increasingly potent ART.
社会心理共病状况对艾滋病毒感染风险的有害影响受到的关注，比对其对艾滋病毒治疗和病毒抑制的潜在影响的关注更多。为了研究共病状况对艾滋病毒护理连续过程的影响，我们分析了2007年至2017年期间，通过综合临床系统艾滋病研究网络中心，在七个地点接受护理的艾滋病毒感染者（n = 14261）的数据，这些感染者每隔约4 - 6个月提供一次患者报告的结果。采用多水平逻辑回归，对共病状况计数（抑郁、焦虑、物质使用和有害饮酒）、性风险组和护理时间进行建模，以预测抗逆转录病毒疗法（ART）的依从性和病毒抑制（艾滋病毒RNA < 400拷贝/毫升）。患者之间比较，每增加一种患者间共病状况，ART依从性的几率降低61.6%[调整后的优势比（AOR）= 0.384；95%置信区间（CI），0.362 - 0.408]；患者自身比较，每增加一种患者内共病状况，ART依从性的几率降低36.4%（AOR = 0.636，95% CI，0.606 - 0.667）。每增加一种患者间共病状况，病毒抑制的几率降低29.3%（AOR = 0.707；95% CI，0.644 - 0.778），每增加一种患者内共病状况，病毒抑制的几率降低27.7%（AOR = 0.723；95% CI，0.671 - 0.780）。在控制依从性的影响（AOR = 5.522；95% CI，4.67 - 6.53）后，每增加一次门诊就诊，病毒抑制的几率高出1.296倍（AOR = 1.296；95% CI，1.22 - 1.38），但共病状况不显著。在诊所内开展有效的干预措施，以识别和治疗共病状况，加强ART依从性，并持续参与护理，有助于控制艾滋病毒流行，即使在抗逆转录病毒疗法日益有效的时代的学术医疗环境中也是如此。
