Outcomes and Predictors of Rapid Antiretroviral Therapy Initiation for People With Newly Diagnosed HIV in an Integrated Health Care System.
Outcomes and Predictors of Rapid Antiretroviral Therapy Initiation for People With Newly Diagnosed HIV in an Integrated Health Care System.
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DOI：
10.1093/ofid/ofad531
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发表时间：
2023-11
影响因子：
4.2
通讯作者：
Luu, Mitchell N.
中科院分区：
文献类型：
--
作者：
Dalal, Avani;Clark, Earl;Samiezade-Yazd, Zahra;Lee-Rodriguez, Christian;Lam, Jennifer O.;Luu, Mitchell N.
快速抗逆转录病毒治疗（ART）是新诊断出的艾滋病毒患者的推荐治疗策略，但支持该策略的文献主要关注短期结果。我们检查了北加州综合医疗保健系统中新诊断出的艾滋病毒患者的快速抗逆转录病毒治疗的长期结果和预测因素。这项观察性队列研究纳入了 2015 年 1 月至 2020 年 12 月期间在北加州凯撒医疗机构新诊断出感染艾滋病毒的成年人。快速 ART 被定义为 HIV 诊断后 7 天内开始 ART。我们收集了人口统计和临床数据，以确定短期和长期结果，包括病毒抑制、护理保留、药物依从性和累积病毒负荷。使用逻辑回归模型来确定快速 ART 启动的预测因素。我们招收了 1409 名成年人； 34.1% 开始快速 ART。快速 ART 组更快地实现病毒抑制（48 天 vs 77 天；P < .001），累积病毒负荷较低（log10 病毒血症拷贝年，3.63 vs 3.82；P < .01），但药物依从性略有降低（74.8% vs 75.2%；P < .01）。在随访期间，快速组的长期病毒抑制和护理保留没有改善。 2017 年之后，患者更有可能开始快速 ART，如果需要翻译，则不太可能。接受快速抗逆转录病毒疗法的患者的累积艾滋病毒负担有所改善，但护理保留和病毒抑制方面没有长期改善。我们的研究结果表明，应该提供快速抗逆转录病毒治疗，但对于新诊断出的艾滋病毒患者可能需要额外的干预措施。
Rapid antiretroviral therapy (ART) is the recommended treatment strategy for patients newly diagnosed with HIV, but the literature supporting this strategy has focused on short-term outcomes. We examined both long-term outcomes and predictors of rapid ART among patients newly diagnosed with HIV within an integrated health care system in Northern California. This observational cohort study included adults newly diagnosed with HIV between January 2015 and December 2020 at Kaiser Permanente Northern California. Rapid ART was defined as ART initiation within 7 days of HIV diagnosis. We collected demographic and clinical data to determine short-term and long-term outcomes, including viral suppression, care retention, medication adherence, and cumulative viral burden. Logistic regression models were used to identify predictors of rapid ART initiation. We enrolled 1409 adults; 34.1% initiated rapid ART. The rapid ART group achieved viral suppression faster (48 vs 77 days; P < .001) and experienced lower cumulative viral burden (log10 viremia copy-years, 3.63 vs 3.82; P < .01) but had slightly reduced medication adherence (74.8% vs 75.2%; P < .01). There was no improvement in long-term viral suppression and care retention in the rapid group during follow-up. Patients were more likely to initiate rapid ART after 2017 and were less likely if they required an interpreter. Patients who received rapid ART had an improved cumulative HIV burden but no long-term improvement in care retention and viral suppression. Our findings suggest that rapid ART should be offered but additional interventions may be needed for patients newly diagnosed with HIV.
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影响因子：
1.2
作者：
Girometti, Nicolo;Nwokolo, Nneka;Whitlock, Gary
通讯作者：
Whitlock, Gary
影响因子：
11.8
作者：
Mugavero, Michael J.;Napravnik, Sonia;Saag, Michael S.
通讯作者：
Saag, Michael S.
DOI：
10.1097/qai.0000000000001134
发表时间：
2017-01-01
期刊：
Journal of acquired immune deficiency syndromes (1999)
影响因子：
--
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
通讯作者：
Hatano H
影响因子：
120.7
作者：
Labhardt, Niklaus D.;Ringera, Isaac;Glass, Tracy R.
通讯作者：
Glass, Tracy R.
影响因子：
7.2
作者：
DEYO, RA;CHERKIN, DC;CIOL, MA
通讯作者：
CIOL, MA