Association African Solidarité, Ouagadougou, Burkina Faso.
TransVIHMI, Univ Montpellier, Inserm, IRD, Montpellier, France.
AIDS. 2021 Nov 1;35(13):2201-2210. doi: 10.1097/QAD.0000000000003046.
To assess the time from HIV diagnosis to ART initiation and the effect of rapid ART initiation (i.e. within 7 days of HIV diagnosis) on attrition and virologic and immunologic responses among MSM in Burkina Faso, Côte d'Ivoire, Mali, and Togo.
Prospective cohort study between 2015 and 2019.
MSM aged 18 years or older newly diagnosed with HIV infection were eligible to participate. ART was proposed to participants upon HIV diagnosis, irrespective of clinical stage and CD4+ cell count, and was initiated as soon as possible, with no specific time frame. Determinants of rapid ART initiation and its effect on treatment outcomes were assessed using multivariate analyses.
Of 350 MSM, 335 (95.7%) initiated ART after a median time of 5 days. Of the latter, 216 (64.5%) had rapid ART initiation. The 335 participants were followed up for a median time of 24.1 months. One hundred and eleven (33.1%) were not retained in care. Rapid ART initiation was less likely in participants with a CD4+ cell count at least 200 cells/μl [adjusted odds ratio (aOR) 0.37, 95% confidence interval (CI) 0.15-0.88]. It improved viral load suppression (aOR 6.96, 95% CI 1.98-24.46) but had no effect on attrition (aOR 0.87, 95% CI 0.57-1.33) or CD4+ cell count increase (adjusted coefficient 28.23, 95% CI -17.00 to 73.45).
These results in MSM in West Africa support the WHO recommendation for rapid ART initiation. Clinics need to develop context-specific strategies for rapid ART initiation and for retaining MSM in HIV care.ClinicalTrials.gov, number NCT02626286.
评估从 HIV 诊断到开始抗逆转录病毒治疗（ART）的时间，以及在布基纳法索、科特迪瓦、马里和多哥的男男性行为者（MSM）中快速开始 ART（即在 HIV 诊断后 7 天内）对流失率以及病毒学和免疫学反应的影响。
2015 年至 2019 年期间进行的前瞻性队列研究。
新诊断为 HIV 感染且年龄在 18 岁或以上的 MSM 有资格参与研究。ART 提议提供给所有 HIV 感染者，不论临床分期和 CD4+细胞计数如何，且应尽快开始，无具体时间框架。使用多变量分析评估快速开始 ART 的决定因素及其对治疗结局的影响。
在 350 名 MSM 中，中位数 5 天后 335 名（95.7%）开始接受 ART。其中，216 名（64.5%）快速开始 ART。335 名参与者的中位随访时间为 24.1 个月。111 名（33.1%）未被保留在治疗中。在 CD4+细胞计数至少 200 个/μl 的参与者中，快速开始 ART 的可能性较低[调整后的优势比（aOR）0.37，95%置信区间（CI）0.15-0.88]。它改善了病毒载量抑制（aOR 6.96，95%CI 1.98-24.46），但对流失率（aOR 0.87，95%CI 0.57-1.33）或 CD4+细胞计数增加（调整系数 28.23，95%CI -17.00 至 73.45）无影响。
这些在西非 MSM 中的结果支持世卫组织快速开始 ART 的建议。诊所需要制定针对快速开始 ART 和保留 MSM 接受 HIV 护理的具体国情策略。临床试验.gov，编号 NCT02626286。
