British Columbia Centre for Excellence in HIV/AIDS, Vancouver, Canada.
Department of Psychology, University of Southampton, Southampton, United Kingdom.
PLoS One. 2022 Oct 21;17(10):e0276596. doi: 10.1371/journal.pone.0276596. eCollection 2022.
In 2010, British Columbia (BC) implemented HIV Treatment as Prevention (TasP) as policy. We examined trends in virologic suppression and determinants of significant viremia among a prospective biobehavioural cohort of men who have sex with men (gbMSM) in Vancouver from 2012-2017.
Respondent-driven sampling was used to recruit sexually active gbMSM (≥16 years) who completed biannual study visits with a computer-assisted self-interview and clinical CD4 and viral load (VL) testing. We linked participant data with the BC HIV Drug Treatment Program to obtain antiretroviral dispensing and VL data. We conducted a trend analysis of VL suppression using univariable generalized estimating equation (GEE) multi-level modelling and multivariable GEE to identify factors associated with episodes of VL ≥200 copies/mL.
Of 774 participants, 223 were living with HIV at baseline and 16 were diagnosed during follow-up (n = 239). We observed a significant trend towards reduced levels of unsuppressed VL (>200 copies/mL) from 22% (07/2012-12/2012) to 12% (07/2016-12/2016) (OR:0.87; 95%CI:0.83-0.91 for each 6-month period). Among those with at least one follow-up visit, (n = 178, median follow-up = 3.2 years, median age = 46.9 years), younger age (aOR:0.97; 95%CI:0.94-0.99, per year), ecstasy use (aOR:1.69; 95%CI:1.13-2.53), crystal methamphetamine use (aOR:1.71; 95%CI:1.18-2.48), seeking sex via websites (aOR:1.46; 95%CI:1.01-2.12), and lower HIV treatment optimism (aOR:0.94; 95%CI:0.90-0.97) were associated with episodes of elevated viremia.
During a period when TasP policy was actively promoted, we observed a significant trend towards reduced levels of unsuppressed VL. Continued efforts should promote HIV treatment optimism and engagement, especially among younger gbMSM and those who use ecstasy and crystal methamphetamine.
2010 年，不列颠哥伦比亚省（BC）将 HIV 治疗即预防（TasP）作为政策实施。我们检查了 2012 年至 2017 年期间，温哥华一名前瞻性生物行为学男男性行为者（gbMSM）队列中病毒学抑制的趋势和显著病毒血症的决定因素。
采用 respondent-driven sampling 招募活跃的 gbMSM（≥16 岁），他们每六个月通过计算机辅助自我访谈和临床 CD4 和病毒载量（VL）检测完成两次研究访问。我们将参与者数据与不列颠哥伦比亚省 HIV 药物治疗计划相关联，以获得抗逆转录病毒药物的配给和 VL 数据。我们使用单变量广义估计方程（GEE）多水平模型和多变量 GEE 对 VL 抑制进行趋势分析，以确定与 VL≥200 拷贝/mL 发作相关的因素。
在 774 名参与者中，223 名在基线时患有 HIV，16 名在随访期间被诊断（n=239）。我们观察到未抑制的 VL（>200 拷贝/mL）水平从 22%（2012 年 7 月至 12 月）到 12%（2016 年 7 月至 12 月）显著下降（OR：0.87；95%CI：0.83-0.91 每 6 个月）。在至少有一次随访的参与者中（n=178，中位随访时间为 3.2 年，中位年龄为 46.9 岁），年龄较小（aOR：0.97；95%CI：0.94-0.99，每年），摇头丸使用（aOR：1.69；95%CI：1.13-2.53），冰毒使用（aOR：1.71；95%CI：1.18-2.48），通过网站寻找性伴侣（aOR：1.46；95%CI：1.01-2.12）和 HIV 治疗乐观程度较低（aOR：0.94；95%CI：0.90-0.97）与病毒血症升高有关。
在 TasP 政策积极推广的时期，我们观察到未抑制的 VL 水平显著下降。应继续努力提高 HIV 治疗的乐观程度和参与度，特别是在年轻的 gbMSM 和使用摇头丸和冰毒的人群中。
