Successes and challenges in optimizing the viral load cascade to improve antiretroviral therapy adherence and rationalize second-line switches in Swaziland.
Successes and challenges in optimizing the viral load cascade to improve antiretroviral therapy adherence and rationalize second-line switches in Swaziland.
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DOI：
10.1002/jia2.25194
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发表时间：
2018-10
影响因子：
6
通讯作者：
Kerschberger B
中科院分区：
文献类型：
--
作者：
Etoori D;Ciglenecki I;Ndlangamandla M;Edwards CG;Jobanputra K;Pasipamire M;Maphalala G;Yang C;Zabsonre I;Kabore SM;Goiri J;Teck R;Kerschberger B
随着抗逆转录病毒治疗（ART）的扩大，更多的患者有资格接受常规病毒载量（VL）监测，这是监测ART疗效的最重要工具。为了使艾滋病毒规划发挥作用，需要尽量减少沿VL级联的泄漏，并优化治疗转换。然而，在资源受限的环境中，许多艾滋病毒规划报告存在重大不足。从斯威士兰农村的一个公共部门艾滋病毒规划中，我们评估了从2013年1月至2014年6月首次VL升高（100 1000拷贝/mL）到2015年12月治疗转换的成人（≥18岁）抗逆转录病毒治疗的VL级反应。我们还描述了病毒学失败患者的HIV耐药性。我们使用描述性统计和Kaplan-Meier估计来描述沿着级联和回归模型的不同步骤，以确定与结果相关的因素。在828例首次VL升高的患者中，252例（30.4%）未接受任何增强依从性咨询（EAC）。696例（84.1%）患者接受了随访VL测量，接受随访VL的预测因子为二线患者(校正风险比（aHR）： 0.72；p = 0.051)、Hlathikhulu健康区（aHR: 0.79; p = 0.013）以及接受过两次EAC治疗（aHR: 1.31; p = 0.023）。410例患者（58.9%）实现了VL再抑制。再抑制的预测因子为50 ~ 64岁(校正优势比：2.02；p = 0.015)，与18至34岁的患者相比，接受二线治疗（aOR: 3.29; p = 0.003）和两次（aOR: 1.66; p = 0.045）或三次（aOR: 1.86; p = 0.003） EAC治疗。在278名符合转为二线治疗条件的患者中，120名（43.2%）在研究结束时转为二线治疗。最后，在155个成功测序的干血斑中，144个（92.9%）来自一线患者。其中133例（阳性预测值：92.4%）存在需要转换治疗的耐药模式。接受抗逆转录病毒治疗的高vl患者如果接受EAC治疗，更有可能出现再抑制。咨询后再抑制失败可预测基因典型证实的需要转换治疗的耐药模式。尽管世卫组织的算法能够预测治疗失败，但切换的延迟是显著的。尽管近年来取得了重大进展，但在资源有限的情况下，加强对VL级联的质量护理的关注至关重要。
As antiretroviral therapy (ART) is scaled up, more patients become eligible for routine viral load (VL) monitoring, the most important tool for monitoring ART efficacy. For HIV programmes to become effective, leakages along the VL cascade need to be minimized and treatment switching needs to be optimized. However, many HIV programmes in resource‐constrained settings report significant shortfalls. From a public sector HIV programme in rural Swaziland, we evaluated the VL cascade of adults (≥18 years) on ART from the time of the first elevated VL (>1000 copies/mL) between January 2013 and June 2014 to treatment switching by December 2015. We additionally described HIV drug resistance for patients with virological failure. We used descriptive statistics and Kaplan–Meier estimates to describe the different steps along the cascade and regression models to determine factors associated with outcomes. Of 828 patients with a first elevated VL, 252 (30.4%) did not receive any enhanced adherence counselling (EAC). Six hundred and ninety‐six (84.1%) patients had a follow‐up VL measurement, and the predictors of receiving a follow‐up VL were being a second‐line patient (adjusted hazard ratio (aHR): 0.72; p = 0.051), Hlathikhulu health zone (aHR: 0.79; p = 0.013) and having received two EAC sessions (aHR: 1.31; p = 0.023). Four hundred and ten patients (58.9%) achieved VL re‐suppression. Predictors of re‐suppression were age 50 to 64 (adjusted odds ratio (aOR): 2.02; p = 0.015) compared with age 18 to 34 years, being on second‐line treatment (aOR: 3.29; p = 0.003) and two (aOR: 1.66; p = 0.045) or three (aOR: 1.86; p = 0.003) EAC sessions. Of 278 patients eligible to switch to second‐line therapy, 120 (43.2%) had switched by the end of the study. Finally, of 155 successfully sequenced dried blood spots, 144 (92.9%) were from first‐line patients. Of these, 133 (positive predictive value: 92.4%) had resistance patterns that necessitated treatment switching. Patients on ART with high VLs were more likely to re‐suppress if they received EAC. Failure to re‐suppress after counselling was predictive of genotypically confirmed resistance patterns requiring treatment switching. Delays in switching were significant despite the ability of the WHO algorithm to predict treatment failure. Despite significant progress in recent years, enhanced focus on quality care along the VL cascade in resource‐limited settings is crucial.
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影响因子：
15.8
作者：
Chung, Michael H.;Richardson, Barbra A.;John-Stewart, Grace C.
通讯作者：
John-Stewart, Grace C.
DOI：
10.1097/qai.0000000000000224
发表时间：
2014-09-01
期刊：
Journal of acquired immune deficiency syndromes (1999)
影响因子：
--
作者：
Jobanputra K;Parker LA;Azih C;Okello V;Maphalala G;Jouquet G;Kerschberger B;Mekeidje C;Cyr J;Mafikudze A;Han W;Lujan J;Teck R;Antierens A;van Griensven J;Reid T
通讯作者：
Reid T
在程序中切换到二线艺术的因果效应，而无需访问常规病毒载荷监测。
DOI：
10.1097/qad.0b013e32834e1b5f
发表时间：
2012-01-02
期刊：
AIDS (London, England)
影响因子：
--
作者：
Gsponer T;Petersen M;Egger M;Phiri S;Maathuis MH;Boulle A;Musondad P;Tweya H;Peter K;Chi BH;Keiser O;IeDEA Southern Africa
通讯作者：
IeDEA Southern Africa
影响因子：
3.8
作者：
Keiser, Olivia;Tweya, Hannock;Egger, Matthias
通讯作者：
Egger, Matthias
影响因子：
120.7
作者：
Grant, RM;Hecht, FM;Kahn, JO
通讯作者：
Kahn, JO