Retention in care is more strongly associated with viral suppression in HIV-infected patients with lower versus higher CD4 counts.
Retention in care is more strongly associated with viral suppression in HIV-infected patients with lower versus higher CD4 counts.
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DOI：
10.1097/qai.0000000000000023
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发表时间：
2014-03-01
期刊：
影响因子：
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通讯作者：
HIV Research Network
中科院分区：
文献类型：
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作者：
Yehia BR;French B;Fleishman JA;Metlay JP;Berry SA;Korthuis PT;Agwu AL;Gebo KA;HIV Research Network
保持护理对所有艾滋病毒感染者都很重要，但对晚期艾滋病毒感染者可能更重要。我们评估了保留护理和病毒抑制之间的关联是否因艾滋病毒疾病严重程度而有所不同。一项重复的横断面分析（2006-2011年）涉及美国18家艾滋病诊所的35,433名成年人。多变量逻辑回归模型检查了保留措施（HRSA保留措施，6个月的间隙和3个月的访视稳定性）和病毒抑制（HIV-1 RNA ≤400拷贝/mL）之间的相关性，HIV疾病严重程度由CD 4计数定义：≤200，201-350，351-500和>500个细胞/mm 3。总体而言，84%的人-年患者符合HRSA指标，76%的人-年患者没有6个月的间隔，37%的人-年患者在所有4个季度都进行了访视; 72%的人-年患者实现了病毒抑制。保留护理和病毒抑制之间的相关性因疾病严重程度而异，并且在CD 4计数较低的患者中最强：≤200 [校正比值比=2.33，95%置信区间2.16-2.51]、201-350 [1.96，1.81-2.12]、351-500 [1.65，1.53-1.78]和>500个细胞/mm 3 [1.22，1.14-1.30]使用HRSA保留措施作为代表性示例。这是第一个报告HIV疾病严重程度对保持护理和病毒抑制的影响的研究之一，表明在CD 4计数较低的患者中，保持护理与病毒抑制的相关性更强。这些结果对于改善晚期HIV患者的健康状况以及HIV预防的检测和治疗方法具有重要意义。
Retention in care is important for all HIV-infected patients, but may be more important for people with advanced HIV disease. We evaluated whether the association between retention in care and viral suppression differed by HIV disease severity. A repeated cross-sectional analysis (2006–2011) involving 35,433 adults at 18 U.S. HIV clinics. Multivariable logistic regression models examined associations between retention measures (HRSA retention measure, 6-month gap, and 3-month visit constancy) and viral suppression (HIV-1 RNA ≤400 copies/mL) for HIV disease severity groups defined by CD4 count: ≤200, 201–350, 351–500, and >500 cells/mm3. Overall, patients met the HRSA measure in 84% of person-years, did not have a 6-month gap in 76%, and had visits in all 4 quarters in 37%; patients achieved viral suppression in 72% of person-years. The association between retention in care and viral suppression differed by disease severity, and was strongest for patients with lower CD4 counts: ≤200 [adjusted odds ratio=2.33, 95% confidence interval 2.16–2.51], 201–350 [1.96, 1.81–2.12], 351–500 [1.65, 1.53–1.78], and >500 cells/mm3 [1.22, 1.14–1.30] using the HRSA retention measure as a representative example. This is one of the first studies to report the impact of HIV disease severity on retention in care and viral suppression, demonstrating that retention in care is more strongly associated with viral suppression in patients with lower CD4 counts. These results have important implications for improving the health of patients with advanced HIV disease and for test and treat approaches to HIV prevention.