Teeraananchai Sirinya, Boettiger David C, Lertpiriyasuwat Cheewanan, Triamwichanon Rattaphon, Benjarattanaporn Patchara, Phanuphak Nittaya
Department of Statistics, Faculty of Science, Kasetsart University, Bangkok, Thailand.
Biomedical Data Science Program, Faculty of Science, Kasetsart University, Bangkok, Thailand.
J Int AIDS Soc. 2025 Jan;28(1):e26406. doi: 10.1002/jia2.26406.
INTRODUCTION: Antiretroviral therapy (ART) initiation, regardless of CD4 count, has been recommended in Thailand since 2014, with same-day initiation recommended since 2021. We assessed HIV treatment outcomes among Thai people living with HIV (PLHIV) by the time from HIV diagnosis to ART initiation under the Universal Health Coverage (UHC) programme and identified factors associated with virological failure (VF). METHODS: PLHIV aged ≥15 years initiating ART between 2014 and 2022 were included from the UHC database. We categorized participants into four groups using the duration from HIV diagnosis to ART initiation: (1) ≤ 7 days (same-day ART); (2) 8 days to <1 month; (3) 1-3 months; and (4) >3 months. Viral load (VL) was measured 6 months after starting ART, and annually thereafter. VF was defined as VL ≥1000 copies/ml. Factors associated with VF were analysed using competing risk models considering death and loss to follow-up (LTFU) as competing events. RESULTS: Among 252,239 PLHIV who started ART, the median age at initiation was 34 years (interquartile range [IQR]: 26-43 years). The median (IQR) pre-ART CD4 count was 233 (76-420) cells/mm. ART initiation occurred within 7 days for 25% (17% on the same day, 8% in 2-7 days), 24% in 8 days to <1 month, 23% in 1-3 months and 28% in >3 months. ART initiation within 7 days increased from 20% (2014-2016) to 32% (2021-2022). VF occurred with a rate of 3.11 (95% CI 3.07-3.159) per 100 person-years (PYs). PLHIV initiating ART 8 days to 1 month were at lower risk of VF (aSHR 0.52, 95% CI 0.50-0.54) when compared to ART initiation >3 months. ART initiation within 7 days resulted in the lowest mortality (6%: 1.28 [95% CI 1.24-1.32] per 100 PYs), but the highest rate of LTFU (12%: 2.69 [95% CI 2.63-2.75] per 100 PYs) when compared to other ART initiation groups. CONCLUSIONS: Although ART initiation within 7 days has increased in Thailand, the overall rate of early initiation remains low. ART initiation within 1 month significantly lowered the risk of VF. ART initiation within 7 days significantly reduced mortality. To further optimize health outcomes, innovative strategies are urgently needed to promote earlier ART initiation in Thailand.
引言：自2014年起，泰国就建议启动抗逆转录病毒疗法（ART），无论CD4细胞计数如何，自2021年起建议当日启动治疗。我们根据全民健康覆盖（UHC）计划，评估了泰国艾滋病毒感染者（PLHIV）从艾滋病毒诊断到开始接受ART治疗的时间内的艾滋病毒治疗结果，并确定了与病毒学失败（VF）相关的因素。 方法：从UHC数据库中纳入2014年至2022年间开始接受ART治疗的年龄≥15岁的PLHIV。我们根据从艾滋病毒诊断到开始接受ART治疗的持续时间将参与者分为四组：（1）≤7天（当日ART）；（2）8天至<1个月；（3）1至3个月；（4）>3个月。在开始ART治疗6个月后测量病毒载量（VL），此后每年测量一次。VF定义为VL≥1000拷贝/毫升。使用竞争风险模型分析与VF相关的因素，将死亡和失访（LTFU）视为竞争事件。 结果：在252,239名开始接受ART治疗的PLHIV中，开始治疗时的中位年龄为34岁（四分位间距[IQR]：26 - 43岁）。ART治疗前的中位（IQR）CD4细胞计数为233（76 - 420）个细胞/mm³。25%的人在7天内开始接受ART治疗（17%在当日，8%在2 - 7天），24%在8天至<1个月，23%在1 - 3个月，28%在>3个月。7天内开始接受ART治疗的比例从2014 - 2016年的20%增加到2021 - 2022年的32%。VF发生率为每100人年3.11（95%CI 3.07 - 3.159）。与>3个月开始接受ART治疗相比，8天至1个月开始接受ART治疗的PLHIV发生VF的风险较低（调整后风险比0.52，95%CI 0.50 - 0.54）。与其他ART治疗开始组相比，7天内开始接受ART治疗导致的死亡率最低（6%：每100人年1.28[95%CI 1.24 - 1.32]），但LTFU率最高（12%：每100人年2.69[95%CI 2.63 - 2.75]）。 结论：尽管泰国7天内开始接受ART治疗的比例有所增加，但早期开始治疗的总体比例仍然较低。1个月内开始接受ART治疗显著降低了VF风险。7天内开始接受ART治疗显著降低了死亡率。为了进一步优化健康结果，迫切需要创新策略来促进泰国更早开始接受ART治疗。
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