AMREF Health Africa, Dar es Salaam, Tanzania.
Department of General Studies, Dar Es Salaam Institute of Technology, Dar es Salaam, Tanzania.
BMC Infect Dis. 2024 Mar 14;24(1):312. doi: 10.1186/s12879-023-08604-2.
Availability and accessibility of Antiretroviral drugs (ARV's) improve the lives of People living with HIV (PLHIV) by improving client's immune system to overcome infections and prevent the development of AIDS and other HIV complications. Combination therapy, early initiation of ART, newer ART drugs, single dosage and drug affordability significantly contribute in the reduction of viral multiplication and suppression of HIV to undetectable plasma levels.
A retrospective longitudinal study design study was conducted from 1 October, 2018 to 30 June 2022 in all supported HIV care and treatment health facilities in Tanga region which were supported by Amref Health Africa, Tanzania. The participants were HIV adult patients aged 15 years and above on ART and attended the clinic at least once after ART initiation. Viral load suppression levels are defined with viral load <1,000 HIV RNA copies/ml (viral load suppression). Cox proportional hazard regression models were employed to identify risk factors for virological failure. P values were two-sided, and we considered a P<0.05 to be statistically significant.
Fifty-nine thousand five hundred three adult clients >15 years whom were on ART were included in the analysis to determine the level of plasma Viral Load suppression after being on ART. Female 41,304 (69.4%) and male 18,199 (30.6%). Only four percent (2,290) were found to be unsuppressed i.e having plasma Viral Load >1,000cp/ml while 96% (57,213) were virally suppressed. Several factors were independently associated with virologic failure that included; age between 15 - <25 years (HR: 2.82, 95% CI 1.96 - 4.04), BMI <18.5 (HR: 1.69, 95% CI 1.23 - 2.30), advanced WHO stage IV (HR: 1.60, 95% CI 1.12 - 2.24), CD4 cell count <350 (HR: 2.61, 95% CI 2.12 - 3.23), poor adherence (HR: 1.98, 95% CI 1.80 - 2.18) and not using DTG based drug (HR: 11.8, 95% CI 9.74 - 14.3).
Virologic failure was observed in this study among clients with young age, advanced WHO stage IV, not using DTG based regimen, poor drug adherence and second line regime. To improve Viral Load Suppression among these clients; the existing HIV intervention strategies should be taken care by targeting the identified risk factors.
抗逆转录病毒药物（ARV）的供应和可及性通过改善患者的免疫系统来提高艾滋病毒感染者（PLHIV）的生活质量，从而克服感染并预防艾滋病和其他 HIV 并发症的发展。联合治疗、ART 的早期启动、新型 ART 药物、单一剂量和药物可负担性显著有助于减少病毒复制和将 HIV 抑制到无法检测到的血浆水平。
本研究采用回顾性纵向研究设计，于 2018 年 10 月 1 日至 2022 年 6 月 30 日在坦噶地区所有由 Amref Health Africa，坦桑尼亚支持的支持艾滋病毒护理和治疗的卫生设施中进行。参与者为年龄在 15 岁及以上、正在接受 ART 治疗的成年 HIV 患者，且在 ART 启动后至少在诊所就诊过一次。病毒载量抑制水平定义为病毒载量<1,000 HIV RNA 拷贝/ml（病毒载量抑制）。采用 Cox 比例风险回归模型确定病毒学失败的危险因素。P 值为双侧，我们认为 P<0.05 为统计学意义。
在接受 ART 治疗的 59530 名 15 岁以上的成年患者中，有 41.304 名（69.4%）为女性，18199 名（30.6%）为男性。只有 4%（2290 人）被发现未被抑制，即血浆病毒载量>1000cp/ml，而 96%（57213 人）的病毒载量得到抑制。年龄在 15-<25 岁（HR：2.82，95%CI 1.96-4.04）、BMI<18.5（HR：1.69，95%CI 1.23-2.30）、晚期世卫组织 IV 期（HR：1.60，95%CI 1.12-2.24）、CD4 细胞计数<350（HR：2.61，95%CI 2.12-3.23）、药物依从性差（HR：1.98，95%CI 1.80-2.18）和未使用 DTG 类药物（HR：11.8，95%CI 9.74-14.3）等因素与病毒学失败独立相关。
本研究中，年轻患者、晚期世卫组织 IV 期、未使用 DTG 类药物、药物依从性差和二线治疗的患者中观察到病毒学失败。为了提高这些患者的病毒载量抑制率，应该针对已确定的风险因素，采取现有的艾滋病毒干预策略。
