在坦桑尼亚北部，一项为期两年的抗逆转录病毒治疗回顾性队列研究：艾滋病毒病毒抑制与病毒反弹风险。

HIV viral suppression and risk of viral rebound in patients on antiretroviral therapy: a two- year retrospective cohort study in Northern Tanzania.

机构信息

College of Health Sciences, Center for Innovative Drug Development and Therapeutic Trials for Africa (CDT-Africa), Addis Ababa University, Addis Ababa, Ethiopia.

Kibong'oto National Infectious Diseases Hospital, Kilimanjaro, Tanzania.

出版信息

BMC Infect Dis. 2024 Apr 11;24(1):390. doi: 10.1186/s12879-024-09161-y.

DOI:10.1186/s12879-024-09161-y

PMID:38605325

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC11007878/

Abstract

BACKGROUND

The world is moving towards the third target of the Joint United Nations Programme on HIV/AIDS to ensure most people receiving antiretroviral therapy (ART) are virologically suppressed. Little is known about viral suppression at an undetectable level and the risk of viral rebound phenomenon in sub-Saharan Africa which covers 67% of the global HIV burden.This study aimed to investigate the proportion of viral suppression at an undetectable level and the risk of viral rebound among people living with HIV receiving ART in northern Tanzania.

METHODOLOGY

A hospital based-retrospective study recruited people living with HIV who were on ART for at least two years at Kibong'oto Infectious Disease Hospital and Mawenzi Regional Referral Hospital in Kilimanjaro Region, Tanzania. Participants' two-year plasma HIV were captured at months 6, 12, and 24 of ART. Undetectable viral load was defined by plasma HIV of viral load (VL) less than 20copies/ml and viral rebound (VR) was considered to anyone having VL of more than 50 copies/ml after having history of undetectable level of the VL less than 20copies/ml. A multivariable log-binomial generalized linear model was used to determine factors for undetectable VL and viral VR.

RESULTS

Among 416 PLHIV recruited, 226 (54.3%) were female. The mean (standard deviation) age was 43.7 (13.3) years. The overall proportion of undetectable VL was 68% (95% CI: 63.3-72.3) and 40.0% had viral rebound (95% CI: 34.7-45.6). Participants who had at least 3 clinic visits were 1.3 times more likely to have undetectable VL compared to those who had 1 to 2 clinic visits in a year (p = 0.029). Similarly, participants with many clinical visits ( > = 3 visits) per year were less likely to have VR compared to those with fewer visits ( = 2 visits) [adjusted relative risk (aRR) = 0.64; 95% CI: 0.44-0.93].

CONCLUSION

Participants who had fewer clinic visits per year(ART refills) were less likely to achieve viral suppression and more likely to experience viral rebound. Enhanced health education and close follow-up of PLHIV on antiretroviral therapy are crucial to reinforce adherence and maintain an undetectable viral load.

摘要

背景

世界正在朝着联合国艾滋病规划署的第三个目标迈进，以确保大多数接受抗逆转录病毒疗法（ART）的人病毒得到抑制。在覆盖全球 67%艾滋病毒负担的撒哈拉以南非洲地区，人们对病毒无法检测到的抑制水平以及病毒反弹现象的风险知之甚少。本研究旨在调查坦桑尼亚北部接受抗逆转录病毒治疗的艾滋病毒感染者中病毒无法检测到的抑制水平和病毒反弹的比例。

方法

这是一项基于医院的回顾性研究，在坦桑尼亚乞力马扎罗地区的基邦戈托传染病医院和曼文齐区域转诊医院招募了至少接受了两年抗逆转录病毒治疗的艾滋病毒感染者。在 ART 的第 6、12 和 24 个月时，采集参与者的两年血浆 HIV。无法检测到的病毒载量定义为血浆 HIV 病毒载量（VL）小于 20 拷贝/ml，病毒反弹（VR）被认为是在 VL 无法检测到低于 20 拷贝/ml 的历史后，VL 超过 50 拷贝/ml 的任何人。使用多变量对数二项式广义线性模型来确定无法检测到 VL 和病毒 VR 的因素。

结果

在招募的 416 名 PLHIV 中，有 226 名（54.3%）为女性。平均（标准差）年龄为 43.7（13.3）岁。总体无法检测到 VL 的比例为 68%（95%CI：63.3-72.3），40.0%的人出现病毒反弹（95%CI：34.7-45.6）。与一年就诊 1 到 2 次的患者相比，至少就诊 3 次的患者更有可能达到无法检测到 VL，[比值比（OR）=1.3；95%CI：1.0-1.7；p=0.046]。同样，每年就诊次数较多（≥3 次）的患者发生 VR 的可能性低于就诊次数较少（=2 次）的患者[调整后的相对风险（aRR）=0.64；95%CI：0.44-0.93]。