Impact of age on retention in care and viral suppression.
Impact of age on retention in care and viral suppression.
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DOI：
10.1097/qai.0000000000000489
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发表时间：
2015-04-01
期刊：
影响因子：
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通讯作者：
North American AIDS Cohort Collaboration on Research and Design (NA-ACCORD)
中科院分区：
文献类型：
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作者：
Yehia BR;Rebeiro P;Althoff KN;Agwu AL;Horberg MA;Samji H;Napravnik S;Mayer K;Tedaldi E;Silverberg MJ;Thorne JE;Burchell AN;Rourke SB;Rachlis A;Mayor A;Gill MJ;Zinski A;Ohl M;Anastos K;Abraham AG;Kitahata MM;Moore RD;Gebo KA;North American AIDS Cohort Collaboration on Research and Design (NA-ACCORD)
保留护理对所有艾滋病毒感染者都很重要，并与开始抗逆转录病毒治疗和病毒抑制密切相关。然而，目前还不清楚护理中的保留和年龄如何相互作用来影响病毒抑制。我们评估了保留和病毒抑制之间的联系是否因进入护理中心的年龄而不同。对美国和加拿大14个临床队列中的17,044名感染艾滋病毒的成年人进行了横断面分析(2006-2010)。患者在第一个完整历年的临床观察中贡献了一年的数据。泊松回归分析了保留措施[美国国家艾滋病毒/艾滋病战略(NHAS)、美国卫生与公众服务部(DHHS)、6个月间隔和3个月访问恒定]与病毒抑制(HIVRNA≤200拷贝/毫升)之间的关系，按年龄组：18-29、30-39、40-49、50-59和≥60岁。总体而言，89%的患者使用NHAS指标保留在护理中，74%的患者使用DHHS指标，85%的患者没有6个月的间隔期，62%的患者在一年中的3-4个季度就诊；54%的患者实现了病毒抑制。对于每个保留措施，与病毒抑制的关联只在较年轻的年龄组(18-29岁和30-39岁)中显著：18-29[调整后的患病率(APR)=1.33，95%可信区间(CI)=1.03-1.70]；30-39(APR=1.23，CI=1.01-1.49)；40-49(APR=1.06，CI=0.90-1.22)；50-59(APR=0.92，CI=0.75-1.13)；≥60年(年利率=0.99，CI=0.63-1.56)。这些结果对改善年轻人的病毒控制具有重要意义，强调了护理中的保留在支持这一人群的病毒抑制方面发挥的关键作用。
Retention in care is important for all HIV-infected persons and is strongly associated with initiation of antiretroviral therapy and viral suppression. However, it is unclear how retention in care and age interact to effect viral suppression. We evaluated whether the association between retention and viral suppression differed by age at entry into care. Cross-sectional analysis (2006-2010) involving 17,044 HIV-infected adults in 14 clinical cohorts across the U.S. and Canada. Patients contributed one year of data during their first full calendar year of clinical observation. Poisson regression examined associations between retention measures [U.S. National HIV/AIDS Strategy (NHAS), U.S. Department of Health and Human Services (DHHS), 6-month gap, and 3-month visit constancy] and viral suppression (HIV RNA ≤200 copies/mL) by age group: 18-29, 30-39, 40–49, 50–59, and ≥60 years old. Overall, 89% of patients were retained in care using the NHAS measure, 74% with the DHHS indicator, 85% did not have a 6-month gap, and 62% had visits in 3-4 quarters of the year; 54% achieved viral suppression. For each retention measure, the association with viral suppression was significant for only the younger age groups (18-29 and 30-39 years): 18-29 [adjusted prevalence ratio (APR)=1.33, 95% confidence interval (CI)=1.03-1.70]; 30-39 (APR=1.23, CI=1.01-1.49); 40-49 (APR=1.06, CI=0.90-1.22); 50-59 (APR=0.92, CI=0.75-1.13); ≥60 years (APR=0.99, CI=0.63-1.56) using the NHAS measure as a representative example. These results have important implications for improving viral control among younger adults, emphasizing the crucial role retention in care plays in supporting viral suppression in this population.