Improved virologic outcomes over time for HIV-infected patients on antiretroviral therapy in a cohort from Rio de Janeiro, 1997-2011.
Improved virologic outcomes over time for HIV-infected patients on antiretroviral therapy in a cohort from Rio de Janeiro, 1997-2011.
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1997-2011 年，来自里约热内卢的一组接受抗逆转录病毒治疗的 HIV 感染者的病毒学结果随着时间的推移有所改善。
DOI：
10.1186/1471-2334-14-322
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发表时间：
2014-06-11
影响因子：
3.7
通讯作者：
Grinsztejn B
中科院分区：
文献类型：
--
作者：
Martin DA;Luz PM;Lake JE;Clark JL;Veloso VG;Moreira RI;Cardoso SW;Klausner JD;Grinsztejn B
先前的队列研究已经证明了抗逆转录病毒疗法(ART)在抑制病毒载量方面的有益效果。我们的目标是研究在巴西里约热内卢的奥斯瓦尔多·克鲁斯基金会的Evandro Chagas临床研究所接受治疗的艾滋病毒感染患者的病毒学抑制相关因素。对1997年至2010年间开始抗逆转录病毒治疗的1,678名18岁的≥初治患者在接近年中的日期(7月1日)的艾滋病毒-1RNA水平和CD_4+T细胞计数进行了评估。使用经临床和人口统计学因素调整的广义估计方程回归模型估计病毒载量(≤)为400拷贝/毫升时的优势比(OR)和95%可信区间(CI)。时间更新的协变量包括年龄、艾滋病毒诊断以来的年限、丙型肝炎诊断和ART中断。在1997年至2011年间，病毒载量未被检测到的患者比例从6%上升到78%，CD_4+T细胞计数的中位数从207[四分位数][162,343]个/μ增加到554[382,743]个/μL。未检测到病毒载量的年调整OR为1.18(95%CI=1.16~1.21)。ART中断&>每日历1个月显著降低了病毒载量无法检测到的几率[AOR=0.32(95%CI=0.27-0.38)]。与开始使用非核苷类逆转录酶抑制剂(NNRTI)的一线方案的患者相比，开始使用基于蛋白水解酶抑制剂(PI)的一线方案的患者不易检测到病毒载量[AOR=0.72(95%CI=0.63-0.83)]。我们的结果表明，从1997年到2011年，病毒学结果有了显著的改善，在对其他因素进行调整后，这种改善仍然存在。这在一定程度上可能是由于护理和新的治疗选择的改善。与之前的研究一致，研究发现，NNRTI与PI为基础的一线方案与病毒载量无法检测到的几率增加有关。治疗中断被发现是没有检测不到的病毒载量的最重要的决定因素。需要进行研究，以确定治疗中断的原因，并制定随后的策略，以提高对ART的依从性。
Previous cohort studies have demonstrated the beneficial effects of antiretroviral therapy (ART) on viral load suppression. We aimed to examine the factors associated with virologic suppression for HIV-infected patients on ART receiving care at the Evandro Chagas Clinical Research Institute, Oswaldo Cruz Foundation in Rio de Janeiro, Brazil. HIV-1 RNA levels and CD4+ T-cell counts at the date closest to midyear (1 July) were evaluated for 1,678 ART-naïve patients ≥18 years of age initiating ART between 1997 and 2010. The odds ratios (OR) and 95% confidence intervals (CI) for having an undetectable viral load (≤400 copies/mL) were estimated using generalized estimating equations regression models adjusted for clinical and demographic factors. Time-updated covariates included age, years since HIV diagnosis, hepatitis C diagnosis and ART interruptions. Between 1997 and 2011, the proportion of patients with an undetectable viral load increased from 6% to 78% and the median [interquartile range] CD4+ T-cell count increased from 207 [162, 343] to 554 [382, 743] cells/μL. Pre-treatment median CD4+ T-cell count significantly increased over the observation period from 114 [37, 161] to 237 [76, 333] cells/μL (p < .001). The per-year adjusted OR (aOR) for having undetectable viral load was 1.18 (95% CI = 1.16-1.21). ART interruptions >1 month per calendar significantly decreased the odds [aOR = 0.32 (95% CI = 0.27-0.38)] of having an undetectable viral load. Patients initiating on a protease inhibitor (PI)-based first-line regimen were less likely to have undetectable viral load [aOR = 0.72 (95% CI = 0.63-0.83)] compared to those initiating on a non-nucleoside reverse transcriptase inhibitor (NNRTI)-based regimen. Our results demonstrate significant improvements in virologic outcomes from 1997 to 2011, which persisted after adjusting for other factors. This may in part be due to improvements in care and new treatment options. NNRTI- versus PI-based first-line regimens were found to be associated with increased odds of having an undetectable viral load, consistent with previous studies. Treatment interruptions were found to be the most important determinant of not having an undetectable viral load. Studies are needed to characterize the reasons for treatment interruptions and to develop subsequent strategies for improving adherence to ART.