高效抗逆转录病毒治疗停药时间与感染人类免疫缺陷病毒（HIV）的移民成年患者治疗失败相关：来自秘鲁转诊医院在委内瑞拉外逃期间的队列研究。

Highly active antiretroviral therapy discontinuation time is associated with therapeutic failure among human immunodeficiency virus (HIV)-infected immigrant adults: A cohort study from a Peruvian referral hospital during the Venezuelan exodus.

机构信息

Facultad de Ciencias de la Salud, Universidad Peruana de Ciencias Aplicadas, Lima, Peru.

Centro de Excelencia en Investigaciones Económicas y Sociales en Salud, Universidad San Ignacio de Loyola, Lima, Peru.

出版信息

Trop Med Int Health. 2023 Aug;28(8):641-652. doi: 10.1111/tmi.13909. Epub 2023 Jul 6.

DOI:10.1111/tmi.13909

PMID:37414409

Abstract

OBJECTIVE

To evaluate the association between Highly Active Antiretroviral Therapy (HAART) discontinuation time and therapeutic failure (TF) in Venezuelan immigrants with HIV that restart HAART.

METHODS

We carried out a retrospective cohort study in a large hospital in Peru. We included Venezuelan immigrants who restarted HAART and were followed over at least 6 months. The primary outcome was TF. Secondary outcomes were immunologic (IF), virologic (VF) and clinical (CF) failures. The exposure variable was HAART discontinuation, categorised as no discontinuation, less than 6 months, and 6 months or more. We applied generalised linear models Poisson family with robust standard errors to calculate crude (cRR) and adjusted (aRR) relative risks by statistical and epidemiological criteria.

RESULTS

We included 294 patients, 97.2% were males, and the median age was 32 years. Out of all the patients, 32.7% discontinued HAART for less than 6 months, 15.0% discontinued for more than 6 months and the remaining 52.3% did not discontinue. The cumulative incidence of TF was 27.9%, 24.5% in VF, 6.0% in IF and 6.0% in CF. Compared with non-discontinued HAART patients, the discontinuation for less than 6 months (aRR = 1.98 [95% CI: 1.27-3.09]) and from 6 months to more (aRR = 3.17 [95% CI: 2.02-4.95]) increased the risk of TF. Likewise, treatment discontinuation of up to 6 months (aRR = 2.32 [95% CI: 1.40-3.84]) and from 6 months to more (aRR = 3.93 [95% CI: 2.39-6.45]) increased the risk of VF.

CONCLUSIONS

HAART discontinuation increases the probability of TF and VF in Venezuelan immigrants.

摘要

目的

评估在重启高效抗逆转录病毒治疗（HAART）的委内瑞拉移民 HIV 感染者中，HAART 停药时间与治疗失败（TF）之间的关联。

方法

我们在秘鲁的一家大型医院进行了一项回顾性队列研究。我们纳入了重启 HAART 并至少随访 6 个月的委内瑞拉移民。主要结局是 TF。次要结局是免疫（IF）、病毒学（VF）和临床（CF）失败。暴露变量是 HAART 停药，分为未停药、少于 6 个月和 6 个月或更长时间。我们应用广义线性模型泊松家族和稳健标准误差，根据统计学和流行病学标准计算粗（cRR）和调整（aRR）相对风险。

结果

我们纳入了 294 名患者，97.2%为男性，中位年龄为 32 岁。所有患者中，32.7%的患者停药时间少于 6 个月，15.0%的患者停药时间超过 6 个月，其余 52.3%的患者未停药。TF 的累积发生率为 27.9%，VF 为 24.5%，IF 为 6.0%，CF 为 6.0%。与未停药的 HAART 患者相比，停药时间少于 6 个月（aRR=1.98[95%CI：1.27-3.09]）和 6 个月至更长时间（aRR=3.17[95%CI：2.02-4.95]）增加了 TF 的风险。同样，6 个月以内的治疗停药（aRR=2.32[95%CI：1.40-3.84]）和 6 个月至更长时间的治疗停药（aRR=3.93[95%CI：2.39-6.45]）增加了 VF 的风险。