Nyaboke Rose, Ramadhani Habib Omari, Lascko Taylor, Awuor Patrick, Kirui Elvis, Koech Emily, Mutisya Immaculate, Ngunu Carol, Wangusi Rebecca
CIHEB Kenya, Nairobi, Kenya.
IHV, University of Maryland School of Medicine, Baltimore, MD, USA.
SAGE Open Med. 2023 Mar 28;11:20503121231162354. doi: 10.1177/20503121231162354. eCollection 2023.
The aim of this study is to estimate the proportion of virologically suppressed People living with HIV on second-line ART and to identify factors associated with virologic suppression. With an increasing population of patients on complex second-line anti retroviral therapy (ART), understanding the factors associated with viral suppression and adherence is critical for ensured longevity of ART.
A retrospective study was conducted of patients on second-line ART in 17 facilities supported by University of Maryland, Baltimore, in Nairobi, Kenya, covering the period beginning October 2016 up to August 2019. Viral suppression was defined as viral load <1000 copies/mL in a test conducted in the last 12 months. Adherence was assessed through self-reports and classified as optimal (good) or suboptimal (inadequate/poor). Associations were presented as adjusted risk ratios with 95% confidence intervals. Statistical significance was considered when value ⩽0.05.
Of 1100 study participants with viral load data, 974 (88.5%) reported optimal adherence while on first-line ART and 1029 (93.5%) reported optimal adherence to second-line ART. Overall, viral load suppression on second-line ART was 90%. Optimal adherence ((adjusted risk ratio) 1.26; 95% confidence interval 1.09-1.46)) and age 35-44 versus 15-24 years ((adjusted risk ratio) 1.06; 95% confidence interval 1.01-1.13)) were associated with viral suppression . Adherence to first-line ART ((adjusted risk ratio) 1.19; 95% confidence interval 1.02-1.40)) was associated with adherence to second-line ART.
Viral suppression remains high and adherence was strongly associated with viral suppression, underscoring the need to adequately address the barriers to adherence before switching regimens.
本研究旨在估算接受二线抗逆转录病毒治疗（ART）的HIV感染者中病毒学抑制的比例，并确定与病毒学抑制相关的因素。随着接受复杂二线抗逆转录病毒治疗（ART）的患者人数不断增加，了解与病毒抑制和依从性相关的因素对于确保ART的长期疗效至关重要。
对肯尼亚内罗毕由巴尔的摩马里兰大学支持的17家机构中接受二线ART的患者进行了一项回顾性研究，涵盖2016年10月至2019年8月期间。病毒抑制定义为在过去12个月内进行的检测中病毒载量<1000拷贝/毫升。通过自我报告评估依从性，并将其分类为最佳（良好）或次优（不足/差）。关联以调整后的风险比和95%置信区间表示。当P值≤0.05时认为具有统计学意义。
在1100名有病毒载量数据的研究参与者中，974名（88.5%）报告在一线ART治疗期间依从性最佳，1029名（93.5%）报告对二线ART治疗依从性最佳。总体而言，二线ART治疗的病毒载量抑制率为90%。最佳依从性（调整后的风险比为1.26；95%置信区间为1.09 - 1.46）以及年龄在35 - 44岁与15 - 24岁相比（调整后的风险比为1.06；95%置信区间为1.01 - 1.13）与病毒抑制相关。对一线ART的依从性（调整后的风险比为1.19；95%置信区间为1.02 - 1.40）与对二线ART的依从性相关。
病毒抑制率仍然很高，且依从性与病毒抑制密切相关，这突出了在更换治疗方案之前充分解决依从性障碍的必要性。
