Chongqing Municipal Center for Disease Control and Prevention, Chongqing, China.
State Key Laboratory of Infectious Disease Prevention and Control, National Center for AIDS/STD Control and Prevention, Chinese Center for Disease Control and Prevention, Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, Beijing, China.
Front Public Health. 2022 Feb 3;10:800839. doi: 10.3389/fpubh.2022.800839. eCollection 2022.
Viral load (VL) is a strong predictor of human immunodeficiency virus (HIV) disease progression. The aim of this study was to evaluate the effect of high baseline VL on antiretroviral therapy (ART) outcomes among HIV-infected patients.
This retrospective study observed HIV-infected patients who had baseline VL test at ART initiation between 2015 and 2019 in Chongqing, China. Cox proportional hazards regression and logistic regression models were used to evaluate the effects of baseline VL on Acquired immunodeficiency syndrome (AIDS)-related mortality and virologic failure, respectively.
The cohort included 7,176 HIV-infected patients, of whom 38.7% had a baseline VL ≥ 100,000 copies/mL. Of the patients who died during follow-up, 58.9% had a baseline VL ≥ 100,000 copies/mL. Compared with a baseline VL < 10,000 copies/mL, ART initiation at VL ≥ 100,000 copies/mL was significantly associated with the AIDS-related death (adjusted hazard ratio, AHR = 1.4) and virologic failure (adjusted odds ratio, AOR = 2.4). Compared with patients with a baseline VL < 10,000 copies/mL, patients on the recommended first-line regimen with a VL ≥ 100,000 copies/mL at ART initiaition had higher mortality rate (5.1 vs. 1.7 per 100 person-years), but there was no significant difference in the mortality accoding to the initial VL level among patients on second-line ART (2.8 vs. 2.7 per 100 person-years). ART initiation ≤ 30 days after HIV diagnosis was associated with a lower risk of AIDS-related death (AHR = 0.6).
ART initiation with VL ≥ 100,000 copies/mL was associated with a significantly greater risk of mortality and virologic failure. Optimizing the ART regimen and initiating ART early may help to reduce mortality effectively among patients with a high baseline VL. VL testing for all HIV patients is recommended at HIV diagnosis or on ART initiation.
病毒载量（VL）是人类免疫缺陷病毒（HIV）疾病进展的强有力预测因子。本研究旨在评估基线 VL 升高对 HIV 感染者抗逆转录病毒治疗（ART）结局的影响。
本回顾性研究观察了 2015 年至 2019 年期间在中国重庆开始 ART 时基线 VL 检测的 HIV 感染者。使用 Cox 比例风险回归和 logistic 回归模型分别评估基线 VL 对获得性免疫缺陷综合征（AIDS）相关死亡率和病毒学失败的影响。
该队列包括 7176 名 HIV 感染者，其中 38.7%的基线 VL≥100000 拷贝/ml。在随访期间死亡的患者中，58.9%的基线 VL≥100000 拷贝/ml。与基线 VL<10000 拷贝/ml 相比，ART 起始时 VL≥100000 拷贝/ml 与 AIDS 相关死亡（调整后的危险比，AHR=1.4）和病毒学失败（调整后的优势比，AOR=2.4）显著相关。与基线 VL<10000 拷贝/ml 的患者相比，基线 VL≥100000 拷贝/ml 且接受推荐一线方案治疗的患者死亡率更高（每 100 人年 5.1 例 vs. 1.7 例），但二线 ART 患者的初始 VL 水平与死亡率之间无显著差异（每 100 人年 2.8 例 vs. 2.7 例）。HIV 诊断后 30 天内开始 ART 与 AIDS 相关死亡风险降低相关（AHR=0.6）。
基线 VL≥100000 拷贝/ml 与死亡率和病毒学失败风险显著增加相关。优化 ART 方案并尽早开始 ART 可能有助于降低高基线 VL 患者的死亡率。建议对所有 HIV 患者在 HIV 诊断或开始 ART 时进行 VL 检测。
