在肯尼亚沿海地区，接受抗逆转录病毒治疗的 18 至 24 岁青年中，HIV 病毒学抑制失败的比例很高。
HIV virological non-suppression is highly prevalent among 18- to 24-year-old youths on antiretroviral therapy at the Kenyan coast.
机构信息
KEMRI-Wellcome Trust Research Programme, Centre for Geographic Medicine Research (Coast), Box 230, Kilifi, Kenya.
Department of Clinical, Neuro- and Developmental Psychology, Amsterdam Public Health Research Institute, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands.
出版信息
BMC Infect Dis. 2022 May 11;22(1):449. doi: 10.1186/s12879-022-07428-w.
BACKGROUND
In sub-Saharan Africa, data on virologic outcomes of young people living with HIV (YLWH) enrolled on antiretroviral therapy (ART) remains scarce. In this study, we describe the prevalence of HIV virological non-suppression (VNS) and its associated factors among YLWH aged 18-24 years from the Kenyan coast.
METHODS
Data were analyzed for 384 YLWH who participated in a larger cross-sectional study conducted between November 2018 and September 2019 in two counties at the Kenyan coast (Kilifi and Mombasa). Descriptive statistics were used to summarize sample characteristics and logistic regression was used for statistical modeling of factors associated with VNS. In this study, VNS was defined as plasma viral load ≥ 1000 copies/mL.
RESULTS
Among these YLWH with a mean age of 20.7 years (SD = 2.2); 55.5% females, the overall prevalence of VNS was 32.0% (95% Confidence interval (95% CI): 27.5, 36.9%). In the multivariable logistic regression analysis, being from a largely rural setting (adjusted Odds Ratio (aOR) 1.73, 95% CI 1.10, 2.71; p = 0.02), underweight (aOR 1.87, 95% CI 1.16, 3.01; p = 0.01) and low self-reported ART adherence (aOR 2.83, 95% CI 1.34, 6.00; p = 0.01) were significantly associated with higher odds of VNS in YLWH.
CONCLUSIONS
In this study, high levels of VNS were observed among YLWH and this was significantly associated with rural residency, nutritional and ART adherence problems. ART adherence counselling and nutritional support and education should be intensified in this setting targeting YLWH residing mostly in rural areas. Given the high frequency of VNS, there is need to closely monitor viral load and profile HIV drug resistance patterns in youths from the Kenyan coast with confirmed virologic failure. The latter will help understand whether drug resistance also contributes to poor viral suppression in addition to, or exclusive of suboptimal ART adherence.
背景
在撒哈拉以南非洲，关于接受抗逆转录病毒疗法（ART）的青少年 HIV 感染者（YLWH）病毒学结局的数据仍然很少。在这项研究中，我们描述了肯尼亚沿海地区年龄在 18-24 岁的 YLWH 中 HIV 病毒学未抑制（VNS）的流行率及其相关因素。
方法
对 2018 年 11 月至 2019 年 9 月在肯尼亚沿海两个县（基利菲和蒙巴萨）进行的一项更大的横断面研究中的 384 名 YLWH 参与者进行了数据分析。使用描述性统计来总结样本特征，并使用逻辑回归对与 VNS 相关的因素进行统计学建模。在这项研究中，VNS 定义为血浆病毒载量≥1000 拷贝/ml。
结果
在这些平均年龄为 20.7 岁（SD=2.2）的 YLWH 中，55.5%为女性，总体 VNS 流行率为 32.0%（95%置信区间（95%CI）：27.5，36.9%）。在多变量逻辑回归分析中，来自主要农村地区（调整优势比（aOR）1.73，95%CI 1.10，2.71；p=0.02）、体重不足（aOR 1.87，95%CI 1.16，3.01；p=0.01）和低自我报告的 ART 依从性（aOR 2.83，95%CI 1.34，6.00；p=0.01）与 YLWH 中 VNS 的更高可能性显著相关。
结论
在这项研究中，YLWH 中观察到高水平的 VNS，这与农村居住、营养和 ART 依从性问题显著相关。应在这一环境中加强针对主要居住在农村地区的 YLWH 的 ART 依从性咨询、营养支持和教育。鉴于 VNS 的高频率，需要密切监测肯尼亚沿海地区经确认病毒学失败的年轻人的病毒载量并分析 HIV 耐药模式。后者将有助于了解耐药性是否除了或除了 ART 依从性不佳之外，也有助于病毒抑制不良。
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