The Kirby Institute, UNSW Sydney, Sydney, NSW, Australia; HIV-NAT, Thai Red Cross AIDS Research Centre, Bangkok, Thailand.
The Kirby Institute, UNSW Sydney, Sydney, NSW, Australia.
Lancet HIV. 2021 Dec;8(12):e766-e775. doi: 10.1016/S2352-3018(21)00265-4.
As countries move towards the UNAIDS's 95-95-95 targets and with strong evidence that undetectable equals untransmittable, it is increasingly important to assess whether those with HIV who are receiving antiretroviral therapy (ART) achieve viral suppression. We estimated the proportions of children and adolescents and adults with viral suppression at 1, 2, and 3 years after initiating ART.
In this retrospective cohort study, seven regional cohorts from the International epidemiology Databases to Evaluate AIDS (IeDEA) consortium contributed data from individuals initiating ART between Jan 1, 2010, and Dec 31, 2019, at 148 sites in 31 countries with annual viral load monitoring. Only people with HIV who started ART after the time a site started routine viral load monitoring were included. Data up to March 31, 2020, were analysed. We estimated the proportions of children and adolescents (aged <18 years at ART initiation) and adults (aged ≥18 years at ART initiation) with viral suppression (viral load <1000 copies per mL) at 1, 2, and 3 years after ART initiation using an intention-to-treat approach and an adjusted approach that accounted for missing viral load measurements.
21 594 children and adolescents (11 812 [55%] female, 9782 [45%] male) from 106 sites in 22 countries and 255 662 adults (163 831 [64%] female, 91 831 [36%] male) from 143 sites in 30 countries were included. Using the intention-to-treat approach, the proportion of children and adolescents with viral suppression was 7303 (36%) of 20 478 at 1 year, 5709 (30%) of 19 135 at 2 years, and 4287 (24%) of 17 589 at 3 years after ART initiation; the proportion of adults with viral suppression was 106 541 (44%) of 240 600 at 1 year, 79 141 (36%) of 220 925 at 2 years, and 57 970 (29%) of 201 124 at 3 years after ART initiation. After adjusting for missing viral load measurements among those who transferred, were lost to follow-up, or who were in follow-up without viral load testing, the proportion of children and adolescents with viral suppression was 12 048 (64% [plausible range 43-81]) of 18 835 at 1 year, 10 796 (62% [41-77]) of 17 553 at 2 years, and 9177 (59% [38-91]) of 15 667 at 3 years after ART initiation; the proportion of adults with viral suppression was 176 964 (79% [53-80]) of 225 418 at 1 year, 145 552 (72% [48-79]) of 201 238 at 2 years, and 115 260 (65% [43-69]) of 178 458 at 3 years after ART initiation.
Although adults with HIV are approaching the global target of 95% viral suppression, progress among children and adolescents is much slower. Substantial efforts are still needed to reach the viral suppression target for children and adolescents.
US National Institutes of Health.
随着各国朝着联合国艾滋病规划署的 95-95-95 目标迈进，并且有强有力的证据表明无法检测到病毒等于无法传播病毒，评估接受抗逆转录病毒疗法 (ART) 的艾滋病毒感染者是否实现病毒抑制变得越来越重要。我们估计在开始接受 ART 后的 1、2 和 3 年内，儿童和青少年以及成年人中有病毒抑制的比例。
在这项回顾性队列研究中，国际艾滋病流行病学数据库评估艾滋病 (IeDEA) 联盟的七个区域队列从 2010 年 1 月 1 日至 2019 年 12 月 31 日在 31 个国家的 148 个地点开始接受 ART 的个体的数据，这些地点每年都进行病毒载量监测。只有在开始常规病毒载量监测后开始接受 ART 的艾滋病毒感染者才被包括在内。截至 2020 年 3 月 31 日进行了数据分析。我们使用意向治疗方法和考虑到缺失病毒载量测量的调整方法，估计开始接受 ART 后 1、2 和 3 年内，儿童和青少年（开始接受 ART 时年龄<18 岁）和成年人（开始接受 ART 时年龄≥18 岁）中有病毒抑制（病毒载量<1000 拷贝/毫升）的比例。
在 22 个国家的 106 个地点，纳入了 21814 名儿童和青少年（11812 名[55%]女性，9782 名[45%]男性）和在 30 个国家的 143 个地点，纳入了 255662 名成年人（163831 名[64%]女性，91831 名[36%]男性）。使用意向治疗方法，1 年内有病毒抑制的儿童和青少年比例为 20478 名中的 7303 名（36%），19135 名中的 5709 名（30%），17589 名中的 4287 名（24%）；成年人中有病毒抑制的比例为 240600 名中的 106541 名（44%），220925 名中的 79141 名（36%），201124 名中的 57970 名（29%）。在考虑到转移、失访或未进行病毒载量检测的随访者中缺失的病毒载量测量后，1 年内有病毒抑制的儿童和青少年比例为 18835 名中的 12048 名（64%[可信区间 43-81]），17553 名中的 10796 名（62%[41-77]），15667 名中的 9177 名（59%[38-91]）；1 年内有病毒抑制的成年人比例为 225418 名中的 176964 名（79%[53-80]），201238 名中的 145552 名（72%[48-79]），178458 名中的 115260 名（65%[43-69]）。
虽然成年艾滋病毒感染者接近全球 95%病毒抑制的目标，但儿童和青少年的进展要慢得多。仍然需要做出巨大努力才能达到儿童和青少年的病毒抑制目标。
美国国立卫生研究院。
