在中低收入国家，艾滋病毒感染者当日开始抗逆转录病毒治疗、失访和病毒载量抑制：系统评价和荟萃分析。

Same-day ART initiation, loss to follow-up and viral load suppression among people living with HIV in low- and middle-income countries: systematic review and meta-analysis.

机构信息

President's Office Regional Administration and Local Government, Ajira Yako, Tanzania.

Center for International Health Education and Biosecurity, Maryland Global Initiatives Corporation affiliate of the University of Maryland Baltimore, Abuja, Nigeria.

出版信息

Pan Afr Med J. 2023 Nov 27;46:92. doi: 10.11604/pamj.2023.46.92.40848. eCollection 2023.

INTRODUCTION

in 2015, the World Health Organization recommended early antiretroviral therapy (ART) initiation after HIV diagnosis. Mixed results on the effect of same-day ART initiation (SDI) over non-same-day ART initiation (NSDI) on loss to follow-up (LTFU) and viral load suppression (VLS) necessitate further evaluation.

METHODS

this was a systematic review and meta-analysis of people living with HIV in low- and middle-income countries (LMICs). Multiple databases were searched from January 2016 to December 2022. VLS was defined as HIV RNA <1,000 or <400 cells/ml, depending on the study. Forest plots were used to present the pooled prevalence and 95% confidence intervals (CIs). Heterogeneity was tested by an I statistic and a p-value of <0.05 indicated its presence. Analyses were performed in STATA.

RESULTS

sixteen studies (5 clinical trials, 10 cohorts, and 1 cross-sectional) were included in the final analysis. Nine studies with 157,633 people living with HIV were analyzed for LTFU and the pooled prevalence of LTFU was 22.0% (95%CI; 18.5-25.7). The pooled prevalence of VLS was 72.7% (95%CI; 65.4-79.5%). The I statistic had a Q value of 200.62 (p<0.001) and 44.63 (p<0.001) for pooled prevalence of LTFU and VLS, respectively. Overall, compared to those who received NSDI, SDI had a significantly increased risk of LTFU (risk difference (RD)=0.04; 95%CI: 0.01-0.07). Although observational studies showed an increased risk of LTFU among SDI compared to NSDI (RD=0.05, 95%CI: 0.02-0.08), clinical trials did not. There was no statistically significant difference in VLS comparing those who received SDI vs NSDI (RD= 0.02, 95%CI: -0.03 - 0.07).

CONCLUSION

nearly two in ten people living with HIV in LMICs who initiated ART were LTFU. SDI was associated with increased risk of LTFU. Efforts to prevent LTFU among those who receive SDI are critical to maximize its potential benefits.

简介

2015 年，世界卫生组织建议在 HIV 诊断后立即开始抗逆转录病毒治疗（ART）。关于当天开始 ART（SDI）与非当天开始 ART（NSDI）对失访（LTFU）和病毒载量抑制（VLS）的影响的混合结果需要进一步评估。

方法

这是一项对中低收入国家（LMICs）HIV 感染者的系统评价和荟萃分析。从 2016 年 1 月到 2022 年 12 月，从多个数据库中进行了搜索。VLS 的定义为 HIV RNA<1000 或<400 个细胞/ml，具体取决于研究。森林图用于呈现汇总的患病率和 95%置信区间（CI）。通过 I 统计量测试异质性，p 值<0.05 表示存在异质性。分析在 STATA 中进行。

结果

最终分析纳入了 16 项研究（5 项临床试验、10 项队列研究和 1 项横断面研究）。对 9 项研究中的 157633 名 HIV 感染者进行了失访分析，失访的汇总患病率为 22.0%（95%CI；18.5-25.7）。VLS 的汇总患病率为 72.7%（95%CI；65.4-79.5%）。I 统计量的 Q 值分别为 200.62（p<0.001）和 44.63（p<0.001），用于汇总 LTFU 和 VLS 的患病率。总体而言，与接受 NSDI 的人相比，SDI 的失访风险显著增加（风险差异（RD）=0.04；95%CI：0.01-0.07）。尽管观察性研究显示 SDI 比 NSDI 增加了失访风险（RD=0.05，95%CI：0.02-0.08），但临床试验并未如此。接受 SDI 与 NSDI 的人相比，VLS 没有统计学上的显著差异（RD=0.02，95%CI：-0.03-0.07）。