Wan Mohamad Darani Wan Nur Syamimi, Chen Xin Wee, Samsudin Ely Zarina, Mohd Nor Fadzilah, Ismail Ismawati
Department of Public Health Medicine, Faculty of Medicine, Universiti Teknologi MARA, Selangor, Malaysia.
HIV Unit, Kuala Lumpur and Putrajaya Federal Territories Health Department (JKWPKLP), Ministry of Health, Kuala Lumpur, Malaysia.
Malays J Med Sci. 2023 Feb;30(1):172-184. doi: 10.21315/mjms2023.30.1.15. Epub 2023 Feb 28.
Concerted efforts have been undertaken to reduce the human immunodeficiency virus (HIV) infection by the year 2030 in Malaysia. A situational analysis of the performance of successful HIV treatment and its determinants is vital; however, this information remains scarce. This study aimed to identify the determinants of undetectable viral load among people living with HIV (PLHIV).
Newly diagnosed HIV cases ( = 493) registered under the Malaysia HIV/AIDS-related national databases from June 2018 to December 2019 were studied. The deterministic matching method was applied to link the records in two national databases (at Kuala Lumpur and Putrajaya Federal Territories Health Department, JKWPKLP HIV line-listing database and National AIDS Registry). Successful HIV treatment, an outcome variable, was measured by the undetectable viral load < 200 copies/mL after 1 year of antiretroviral therapy initiation. Logistic regression analysis was applied in the current study.
Results showed that 454/493 (92.2%; 95% confidence interval [CI]: 89.8%, 94.6%) PLHIV had successful HIV treatment. Study participants had a mean (SD) age of 30 (8.10) years old, predominantly male (96.1%) and sexually transmission (99.9%). The multiple logistic regression analysis revealed two significant determinants including the timing of ART initiation (AOR = 3.94; 95% CI: 1.32, 11.70; = 0.014) and establishment of Sexually Transmitted Infection Friendly Clinic (STIFC) (AOR = 3.40; 95% CI: 1.47, 7.85; = 0.004). Non-significant variables included gender, education level, HIV risk exposure, and co-infections of tuberculosis and Hepatitis C.
JKWPKLP is on the right track to achieving universal treatment as a prevention strategy. Reinforcement of early ART initiation and establishment of STIFC are recommended.
马来西亚已齐心协力在2030年前减少人类免疫缺陷病毒（HIV）感染。对成功的HIV治疗表现及其决定因素进行现状分析至关重要；然而，此类信息仍然匮乏。本研究旨在确定HIV感染者（PLHIV）中病毒载量不可检测的决定因素。
对2018年6月至2019年12月在马来西亚HIV/AIDS相关国家数据库中登记的新诊断HIV病例（n = 493）进行研究。采用确定性匹配方法将两个国家数据库（吉隆坡和布城联邦直辖区卫生部、JKWPKLP HIV病例清单数据库和国家艾滋病登记处）中的记录相链接。成功的HIV治疗作为一个结果变量，通过抗逆转录病毒治疗开始1年后病毒载量<200拷贝/mL不可检测来衡量。本研究应用了逻辑回归分析。
结果显示，454/493（92.2%；95%置信区间[CI]：89.8%，94.6%）的PLHIV获得了成功的HIV治疗。研究参与者的平均（标准差）年龄为30（8.10）岁，主要为男性（96.1%）且通过性传播（99.9%）。多元逻辑回归分析揭示了两个重要的决定因素，包括开始抗逆转录病毒治疗的时机（调整后比值比[AOR]=3.94；95%CI：1.32，11.70；P = 0.014）和建立性传播感染友好诊所（STIFC）（AOR = 3.40；95%CI：1.47，7.85；P = 0.004）。无统计学意义的变量包括性别、教育水平、HIV风险暴露以及结核病和丙型肝炎合并感染。
JKWPKLP在实现作为预防策略的普遍治疗方面步入了正轨。建议加强早期抗逆转录病毒治疗的启动并建立STIFC。
