The Effect of Same-Day Observed Initiation of Antiretroviral Therapy on HIV Viral Load and Treatment Outcomes in a US Public Health Setting.
The Effect of Same-Day Observed Initiation of Antiretroviral Therapy on HIV Viral Load and Treatment Outcomes in a US Public Health Setting.
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DOI：
10.1097/qai.0000000000001134
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发表时间：
2017-01-01
期刊：
影响因子：
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通讯作者：
Hatano H
中科院分区：
文献类型：
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作者：
Pilcher CD;Ospina-Norvell C;Dasgupta A;Jones D;Hartogensis W;Torres S;Calderon F;Demicco E;Geng E;Gandhi M;Havlir DV;Hatano H
抗逆转录病毒疗法通常在艾滋病毒诊断后数周开始。我们评估了在诊断当天开始ART的可接受性、可行性、安全性和有效性。我们研究了一个基于临床的队列，该队列由2013年6月至2014年12月期间被新诊断为HIV的连续患者组成。急性或近期感染（<6个月）或CD 4 <200的患者子集根据“快速”护理启动方案进行管理。一个密集的，同一天的预约包括社会需求评估;医疗提供者评估;和第一次ART剂量后，提供实验室提请。在RAPID参与者和同期患者（未提供该项目）以及历史队列之间比较了患者对ART的接受程度、药物毒性、耐药性和至病毒抑制结局的时间。在86例患者中，39例合格，并根据RAPID方案进行管理。RAPID组39例患者中有37例（94.9%）在24小时内开始抗逆转录病毒治疗。两名（5.1%）干预患者发生了初始方案的轻微毒性，而非干预组中没有发生。研究期间，干预组（10.3%）和非干预组（14.9%）的失访率相似。与在同一诊所接受先前推荐的通用ART治疗的患者相比，干预治疗患者的病毒学抑制时间（<200拷贝HIV RNA/mL）明显更快（中位数1.8个月）（4.3个月; p=0.0001）。HIV感染的治疗可以在诊断当天开始，而不会影响ART的安全性或可接受性。当天ART可以缩短病毒抑制的时间。
ART is typically begun weeks after HIV diagnosis. We assessed the acceptability, feasibility, safety and efficacy of initiating ART on the same day as diagnosis. We studied a clinic-based cohort consisting of consecutive patients who were referred with new HIV diagnosis between June 2013 and December 2014. A subset of patients with acute or recent infection (<6 months) or CD4<200 were managed according to a “RAPID” care initiation protocol. An intensive, same-day appointment included social needs assessment; medical provider evaluation; and a first ART dose offered after labs were drawn. Patient acceptance of ART, drug toxicities, drug resistance and time to viral suppression outcomes were compared between RAPID participants and contemporaneous patients (who were not offered the program), as well as with an historical cohort. Among 86 patients, 39 were eligible and managed on the RAPID protocol. 37 (94.9%) of 39 in RAPID began ART within 24 hours. Minor toxicity with the initial regimen occurred in two (5.1%) of intervention patients versus none in the non-intervention group. Loss to follow-up was similar in intervention (10.3%) and non-intervention patients (14.9%) during the study. Time to virologic suppression (<200 copies HIV RNA/mL) was significantly faster (median 1.8 months) among intervention-managed patients when compared with patients treated in the same clinic under prior recommendations for universal ART (4.3 months; p=0.0001). Treatment for HIV infection can be started on the day of diagnosis without impacting the safety or acceptability of ART. Same-day ART may shorten the time to virologic suppression.