Ma Yunqing, Zhang Jiajia, Xiao Jiayang, Yang Xueying, Weissman Sharon, Li Xiaoming, Olatosi Bankole
Department of Epidemiology and Biostatistics, Arnold School of Public Health, University of South Carolina, Columbia, South Carolina, USA.
South Carolina SmatState Center for Healthcare Quality, Arnold School of Public Health, University of South Carolina, Columbia, South Carolina, USA.
AIDS Res Hum Retroviruses. 2025 May;41(5):253-262. doi: 10.1089/aid.2024.0035. Epub 2024 Dec 16.
Monitoring HIV viral rebound (VR) is crucial, as it indicates an increased risk of infection, transmission, disease progression, and drug resistance. This study aims to identify the association between dynamic VR and historical viral load (VL)/CD4 count measures. Fifteen-year South Carolina population-based electronic health record data were used for the study. VR was defined as the return of detectable levels of VL (>200 copies/mL) after stable viral suppression (VS) (two consecutive VS, i.e., VL ≤200 copies/mL). A generalized linear mixed model was used to evaluate the association between dynamic VR and historical time-dependent predictors, such as nadir CD4 count and comorbidities, within a year prior to each VR. Subgroup analysis for men who have sex with men (MSM) was also conducted. Among 8,185 people with HIV (PWH), 1,173 (14.3%) had a history of VR. Lower nadir CD4 count (≥500 vs. <200 cells/µL; adjusted odds ratio [aOR]: 0.51, 95% confidence interval [CI]: [0.43, 0.60]), younger age (>60 years old vs. 18-30 years old; aOR: 0.43, 95% CI: [0.29, 0.63]), and being Black (Black vs. White; aOR: 1.58, 95% CI: [1.34, 1.85]) were associated with a higher risk of VR, while MSM (MSM vs. heterosexual; aOR: 0.81, 95% CI: [0.67, 0.96]) were associated with decreased VR risk. The rate of VR among PWH in South Carolina is significant. Within-1-year VL/CD4 test is critical for identifying PWH at risk for VR. Tailored interventions are needed for PWH at risk for VR to achieve sustained suppression and better health outcomes.
监测HIV病毒反弹（VR）至关重要，因为它表明感染、传播、疾病进展和耐药风险增加。本研究旨在确定动态VR与历史病毒载量（VL）/CD4细胞计数指标之间的关联。研究使用了南卡罗来纳州基于人群的15年电子健康记录数据。VR被定义为在稳定病毒抑制（VS）（连续两次VS，即VL≤200拷贝/mL）后可检测到的VL水平（>200拷贝/mL）的恢复。使用广义线性混合模型来评估动态VR与每次VR前一年内的历史时间依赖性预测因素之间的关联，如最低点CD4细胞计数和合并症。还对男男性行为者（MSM）进行了亚组分析。在8185名艾滋病毒感染者（PWH）中，1173人（14.3%）有VR病史。较低的最低点CD4细胞计数（≥500 vs.<200个细胞/µL；调整优势比[aOR]：0.51，95%置信区间[CI]：[0.43, 0.60]）、较年轻的年龄（>60岁 vs. 18 - 30岁；aOR：0.43，95% CI：[0.29, 0.63]）以及黑人（黑人 vs. 白人；aOR：1.58，95% CI：[1.34, 1.85]）与较高的VR风险相关，而MSM（MSM vs. 异性恋；aOR：0.81，95% CI：[0.67, 0.96]）与较低的VR风险相关。南卡罗来纳州PWH中的VR发生率很高。一年内的VL/CD4检测对于识别有VR风险的PWH至关重要。对于有VR风险的PWH需要采取针对性干预措施，以实现持续抑制并获得更好的健康结果。
