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两个欧洲国家中乌克兰移民的艾滋病护理:情况都一样吗?

HIV Care in Ukrainian Migrants in Two European Countries: All the Same?

作者信息

van Bremen Kathrin, Parczewski Miłosz, Monin Malte, Leszczyszyn-Pynka Magdalena, Schlabe Stefan, Lenkiewicz Franciszek, Karasińska-Cieślak Malwina, Wasmuth Jan-Christian, Witak-Jędra Magdalena, Breitschwerdt Sven, Rockstroh Jürgen K, Zhyvytsia Dmytro, Boesecke Christoph, Chober Daniel, Aksak-Wąs Bogusz

机构信息

Bonn University Hospital, 53127 Bonn, Germany.

German Centre for Infection Research (DZIF), 53127 Bonn, Germany.

出版信息

Pathogens. 2024 Jul 26;13(8):621. doi: 10.3390/pathogens13080621.

Abstract

War in Ukraine prompted an enormous refugee influx into Europe, including approximately 4200 people with HIV. The unique healthcare features of Ukrainian refugees living with HIV were compared between two infectious disease departments in Bonn, Germany, and Szczecin, Poland. This is a retrospective study on 161 people living with HIV (PLWH) refugees from Ukraine seeking care in Bonn (n = 30) and Szczecin (n = 131) between April 2022 and May 2023. Demographic, virologic, immunologic, and coinfection data were analyzed. The majority of the studied individuals were female: 64% (n = 84) in Szczecin and 60% (n = 18) in Bonn. The main HIV transmission mode was heterosexual sex in 73.5% (n = 114). All were on combined antiretroviral therapy (cART) on arrival, primarily on the TLD regimen (TDF/3TC/DTG) (68.4%, n = 106). In Germany, cART was most frequently switched to BIC/TAF/FTC in 83.4% (n = 25); in Poland, the most common combination was TDF/FTC + DTG (58%, n = 76). A prevalence of replicating hepatitis C was in 11.7% (n = 15), and that for chronic hepatitis B (HBV) was in 4.7% (n = 4). History of past tuberculosis was reported in 16.9% (n = 14, Poland, and n = 7, Germany). Follow-up after 6 months showed immunological reconstitution with a mean increase of CD4+ of 10 (IQR: -69.5-120.5) cells/µL in Poland and 51.5 (IQR: -22.5-135.5) cells/µL in Germany; = 0.04. Virologic suppression (<40 HIV-RNA/mL) was high in care entry (n = 62; 98%) for Poland, and n = 26 (92.6%) for Germany, and suppression was achieved in the majority of patients in the 6-month control (89.7% in Poland vs. 95.7% in Germany). Health challenges posed by war migration extend beyond HIV to coinfections as HBV, HCV, and tuberculosis give an indication for a broader search for coinfections, often less common in the new country.

摘要

乌克兰战争促使大量难民涌入欧洲,其中包括约4200名艾滋病毒感染者。德国波恩和波兰什切青的两个传染病科室对乌克兰艾滋病毒感染难民的独特医疗特征进行了比较。这是一项回顾性研究,研究对象为2022年4月至2023年5月期间在波恩(n = 30)和什切青(n = 131)寻求治疗的161名来自乌克兰的艾滋病毒感染者难民。分析了人口统计学、病毒学、免疫学和合并感染数据。研究对象中大多数为女性:什切青为64%(n = 84),波恩为60%(n = 18)。主要的艾滋病毒传播方式为异性性行为,占73.5%(n = 114)。所有患者抵达时均接受联合抗逆转录病毒治疗(cART),主要采用TLD方案(替诺福韦二吡呋酯/拉米夫定/多替拉韦)(68.4%,n = 106)。在德国,83.4%(n = 25)的患者cART最常更换为比克替拉韦/丙酚替诺福韦/恩曲他滨;在波兰,最常见的组合是替诺福韦二吡呋酯/恩曲他滨 + 多替拉韦(58%,n = 76)。丙型肝炎病毒复制的患病率为11.7%(n = 15),慢性乙型肝炎(HBV)的患病率为4.7%(n = 4)。有既往结核病病史的报告率为16.9%(波兰n = 14,德国n = 7)。6个月后的随访显示,波兰的CD4+平均增加10(四分位间距:-69.5 - 120.5)个细胞/微升,德国为51.5(四分位间距:-22.5 - 135.5)个细胞/微升;P = 0.04。在开始治疗时,波兰(n = 62;98%)和德国(n = 26;92.6%)的病毒学抑制(艾滋病毒RNA < 40拷贝/毫升)率很高,并且在6个月的对照中大多数患者实现了病毒学抑制(波兰为89.7%,德国为95.7%)。战争移民带来的健康挑战不仅限于艾滋病毒,还包括合并感染,如HBV、HCV和结核病,这表明需要更广泛地筛查合并感染,而这些合并感染在新国家往往不太常见。

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