National Center for Epidemiology, Instituto de Salud Carlos III.
Centre of Biomedical Research for Infectious Diseases (CIBERINFEC), Madrid.
AIDS. 2023 Jul 1;37(8):1277-1284. doi: 10.1097/QAD.0000000000003552. Epub 2023 Mar 21.
We estimated the incidence rate of HIV medical care interruption (MCI) and its evolution over a 16-year-period, and identified associated risk factors among HIV-positive individuals from the Cohort of the Spanish AIDS Research Network in 2004-2020.
We included antiretroviral-naive individuals aged at least 18 years at enrolment, recruited between January 1, 2004, and August 30, 2019, and followed-up until November 30, 2020.
Individuals with any time interval of at least 15 months between two visits were defined as having a MCI. We calculated the incidence rate (IR) of having at least one MCI and used multivariable Poisson regression models to identify associated risk factors.
Of 15 274 individuals, 5481 (35.9%) had at least one MCI. Of those, 2536 (46.3%) returned to HIV care after MCI and 3753 (68.5%) were lost to follow-up at the end of the study period. The incidence rate (IR) of MCI was 7.2/100 person-years (py) [95% confidence interval (CI): 7.0-7.4]. The annual IR gradually decreased from 20.5/100 py (95% CI: 16.4-25.6) in 2004 to 4.9/100 py (95% CI: 4.4-5.5) in 2014, a slight increase was observed between 2015 and 2018, reaching 9.3/100 py (95% CI: 8.6-10.2) in 2019. Risk factors for MCI included younger age, lower educational level, having contracted HIV infection through injecting drug use or heterosexual intercourse, having been born outside of Spain, and CD4 + cell count >200 cell/μl, viral load <100 000 and co-infection with hepatitis C virus at enrolment.
Around a third of individuals had at least one MCI during the follow-up. Identified predictors of MCI can help health workers to target and support most vulnerable individuals.
我们估计了在 16 年期间 HIV 医疗中断（MCI）的发生率及其演变，并确定了 2004-2020 年期间西班牙艾滋病研究网络队列中 HIV 阳性个体的相关危险因素。
我们纳入了年龄至少 18 岁、在 2004 年 1 月 1 日至 2019 年 8 月 30 日之间入组、随访至 2020 年 11 月 30 日的初治抗逆转录病毒个体。
将两次就诊之间至少有 15 个月时间间隔的个体定义为发生 MCI。我们计算了至少发生一次 MCI 的发生率（IR），并使用多变量泊松回归模型确定了相关的危险因素。
在 15274 名个体中，5481 名（35.9%）至少发生了一次 MCI。其中，2536 名（46.3%）在 MCI 后返回 HIV 护理，3753 名（68.5%）在研究结束时失访。MCI 的发生率（IR）为 7.2/100 人年（95%置信区间[CI]：7.0-7.4）。IR 从 2004 年的 20.5/100 人年（95%CI：16.4-25.6）逐渐下降到 2014 年的 4.9/100 人年（95%CI：4.4-5.5），2015 年至 2018 年略有上升，2019 年达到 9.3/100 人年（95%CI：8.6-10.2）。MCI 的危险因素包括年龄较小、教育程度较低、通过注射吸毒或异性性传播感染 HIV、出生于西班牙境外，以及在入组时 CD4+细胞计数>200 个/μl、病毒载量<100000 个拷贝/ml 和合并丙型肝炎病毒感染。
在随访期间，约三分之一的个体至少发生了一次 MCI。确定的 MCI 预测因素可以帮助卫生工作者针对和支持最脆弱的个体。
