Department of Epidemiology, School of Public Health, Cheeloo College of Medicine, Shandong University, Jinan, Shandong, China.
Institution for Acquired Immunodeficiency Syndrome (AIDS)/Sexually Transmitted Diseases (STD) Control and Prevention, Jinan Center for Disease Control and Prevention, Jinan, Shandong, China.
Front Public Health. 2023 May 9;11:1137132. doi: 10.3389/fpubh.2023.1137132. eCollection 2023.
BACKGROUND: Treatment interruption has been found to increase the risk of opportunistic infections and death among HIV-positive adults, posing a challenge to fully realizing antiretroviral therapy (ART). However, it has been observed that short-term interruption (<16 weeks) was not associated with significant increases in adverse clinical events. There remains a dearth of evidence concerning the interruption and resumption of ART after short-term discontinuation in China. METHODS: HIV-positive adults who initiated ART in Jinan between 2004 and 2020 were included in this study. We defined ART interruption as more than 30 consecutive days off ART and used Cox regression to identify predictors of interruption. ART resumption was defined as a return to ART care within 16 weeks following discontinuation, and logistic regression was used to identify barriers. RESULTS: A total of 2,506 participants were eligible. Most of them were male [2,382 (95%)] and homosexual [2,109 (84%)], with a median age of 31 (IQR: 26-40) years old. Of all participants, 312 (12.5%) experienced a treatment interruption, and the incidence rate of interruption was 3.2 (95% CI: 2.8-3.6) per 100 person-years. A higher risk of discontinuation was observed among unemployed individuals [adjusted hazard ratio (aHR): 1.45, 95% CI: 1.14-1.85], with a lower education level (aHR: 1.39, 95% CI: 1.06-1.82), those with delayed ART initiation (aHR: 1.43, 95% CI: 1.10-1.85), receiving Alafenamide Fumarate Tablets at ART initiation (aHR: 5.19, 95% CI: 3.29-8.21). About half of the interrupters resumed ART within 16 weeks, and participants who delayed ART initiation, missed the last CD4 test before the interruption and received the "LPV/r+NRTIs" regimen before the interruption were more likely to discontinue treatment for the long term. CONCLUSION: Antiretroviral treatment interruption remains relatively prevalent among HIV-positive adults in Jinan, China, and assessing socioeconomic status at treatment initiation will help address this issue. While almost half of the interrupters returned to care within 16 weeks, further focused measures are necessary to reduce long-term interruptions and maximize the resumption of care as soon as possible to avoid adverse clinical events.
背景：治疗中断已被发现会增加 HIV 阳性成年人发生机会性感染和死亡的风险，这对实现抗逆转录病毒治疗（ART）提出了挑战。然而，已经观察到短期中断（<16 周）不会显著增加不良临床事件的风险。在中国，关于短期停药后中断和恢复 ART 的证据仍然不足。
方法：本研究纳入了 2004 年至 2020 年期间在济南开始接受 ART 的 HIV 阳性成年人。我们将 ART 中断定义为超过 30 天未接受 ART，并使用 Cox 回归来确定中断的预测因素。ART 恢复定义为在停药后 16 周内重新开始 ART 治疗，使用逻辑回归来确定障碍。
结果：共有 2506 名参与者符合条件。他们大多数是男性[2382（95%）]和同性恋者[2109（84%）]，中位年龄为 31（IQR：26-40）岁。所有参与者中，有 312 人（12.5%）经历了治疗中断，中断率为 3.2（95%CI：2.8-3.6）/100 人年。失业者中断治疗的风险更高[调整后的危险比（aHR）：1.45，95%CI：1.14-1.85]，受教育程度较低者（aHR：1.39，95%CI：1.06-1.82），延迟开始 ART 者（aHR：1.43，95%CI：1.10-1.85），起始 ART 时使用富马酸丙酚替诺福韦片者（aHR：5.19，95%CI：3.29-8.21）。大约一半的中断者在 16 周内恢复了 ART，而延迟开始 ART、中断前最后一次 CD4 检测错过、中断前接受“LPV/r+NRTIs”方案的参与者更有可能长期停止治疗。
结论：在中国济南，HIV 阳性成年人的抗逆转录病毒治疗中断仍然相对普遍，在开始治疗时评估社会经济状况将有助于解决这一问题。虽然近一半的中断者在 16 周内恢复了治疗，但仍需要采取进一步的重点措施，以减少长期中断，并尽快恢复治疗，以避免不良临床事件。
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