Antiretroviral therapy uptake and predictors of virological failure in patients with HIV receiving first-line and second-line regimens in Johannesburg, South Africa: a retrospective cohort data analysis.
Antiretroviral therapy uptake and predictors of virological failure in patients with HIV receiving first-line and second-line regimens in Johannesburg, South Africa: a retrospective cohort data analysis.
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DOI：
10.1136/bmjopen-2021-054019
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发表时间：
2022-04-15
期刊：
影响因子：
2.9
通讯作者：
Lalla-Edward, Samanta Tresha
中科院分区：
文献类型：
--
作者：
Gumede, Siphamandla Bonga;Venter, Francois;de Wit, John;Wensing, Annemarie;Lalla-Edward, Samanta Tresha
本研究描述了南非一个大型队列中接受一线和二线抗逆转录病毒治疗（ART）方案的HIV患者的人口统计学资料、治疗信息以及与病毒学失败和失访（LTFU）相关的已确定特征。使用次要数据分析的定量回顾性队列研究。七个约翰内斯堡内城设施。包括2004年4月1日至2020年2月29日期间任何时间点接受抗逆转录病毒治疗的123，002名艾滋病毒感染者的独特记录。收集人口统计学特征、ART状态、CD 4计数信息和保留状态，并作为结局的协变量（病毒载量（VL）和LTFU）进行分析。在所有研究患者中，95%（n= 117260）接受一线方案治疗，5%（n=5742）接受二线方案治疗。近三分之二为女性（64%，n=79 226）。大多数患者（60%，n=72 430）开始接受基于依法韦仑、基于替诺福韦酯和基于恩曲他滨的方案（固定剂量复方制剂）。截至2020年2月底，91%（n=76 737）的患者自开始接受ART治疗以来至少达到一次病毒抑制，60%（n=57 981）的患者仍在接受治疗。来自社区卫生中心和初级卫生保健诊所的患者不仅更有可能被病毒抑制，而且更有可能是LTFU。二线治疗方案患者达到病毒抑制的可能性较低（调整后OR（aOR）=0.26，CI=0.23 - 0.28），更可能为LTFU（aOR=1.21，CI=1.09 - 1.35）。年龄较大（≥25岁）和近期CD 4细胞计数≥100个细胞/µL是ART患者病毒抑制和滞留的预测因素。一线治疗方案患者的VL抑制率较高，并且比二线治疗方案患者更有可能继续接受治疗。年轻和CD 4细胞计数低与不良结局相关，这表明ART依从性支持的优先群体。
This study described the demographics, treatment information and identified characteristics associated with virological failure and being lost to follow-up (LTFU) for patients with HIV on first-line and second-line antiretroviral therapy (ART) regimens in a large South African cohort. A quantitative retrospective cohort study using secondary data analysis. Seven Johannesburg inner city facilities. Unique records of 123 002 people with HIV receiving ART at any point in the period 1 April 2004 to 29 February 2020 were included. Demographic characteristics, ART status, CD4 count information and retention status were collected and analysed as covariates of outcomes (viral load (VL) and LTFU). Of the total study patients, 95% (n=1 17 260) were on a first-line regimen and 5% (n=5742) were on a second-line regimen. Almost two-thirds were female (64%, n=79 226). Most patients (60%, n=72 430) were initiated on an efavirenz-based, tenofovir disoproxil fumarate-based and emtricitabine-based regimen (fixed-dose combination). 91% (n=76 737) achieved viral suppression at least once since initiating on ART and 60% (n=57 981) remained in care as at the end of February 2020. Patients from the community health centre and primary healthcare clinics were not only more likely to be virally suppressed but also more likely to be LTFU. Patients on second-line regimens were less likely to reach viral suppression (adjusted OR (aOR)=0.26, CI=0.23 to 0.28) and more likely to be LTFU (aOR=1.21, CI=1.09 to 1.35). Being older (≥25 years) and having a recent CD4 cell count≥100 cells/µL were predictors of viral suppression and retention in patients on ART. Patients on first-line regimens had higher VL suppression rates and were more likely to remain in care than those on a second-line regimen. Being younger and having low CD4 cell counts were associated with poor outcomes, suggesting priority groups for ART adherence support.
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