First Demonstration Project of Long-Acting Injectable Antiretroviral Therapy for Persons With and Without Detectable Human Immunodeficiency Virus (HIV) Viremia in an Urban HIV Clinic.
First Demonstration Project of Long-Acting Injectable Antiretroviral Therapy for Persons With and Without Detectable Human Immunodeficiency Virus (HIV) Viremia in an Urban HIV Clinic.
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DOI：
10.1093/cid/ciac631
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发表时间：
2023-02-08
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长效注射抗逆转录病毒疗法（LAI-ART）被批准用于未经治疗或有经验的人类免疫缺陷病毒（HIV; PWH）患者，其试验仅包括病毒抑制的参与者。我们进行了第一个LAI-ART示范项目，包括由于坚持口服ART的挑战而无法实现或维持病毒抑制的PWH。86号病房是旧金山弗朗西斯科的一家大型艾滋病诊所，为公共保险和保险不足的患者提供服务。我们通过提供者转诊、多学科审查（医学博士、注册护士、药剂师）和监测按时注射的结构化过程开始患者接受LAI-ART。入选标准是愿意接受每月注射和可靠的联系方法。在2021年6月至2022年4月期间，51名患者启动了LAI-ART，其中39名患者在数据库关闭时接受了至少2次随访注射（中位年龄为46岁; 90%为顺性别男性，61%为非白人，41%为边缘居住，54%目前使用兴奋剂）。在24例开始注射病毒抑制剂的患者中（中位CD 4细胞计数，706个细胞/mm 3），100%（95%置信区间[CI]，86%-100%）维持病毒抑制。在15例开始注射时可检测到病毒血症的患者中（中位CD 4细胞计数，99个细胞/mm 3;平均log 10病毒载量，4.67;标准差，1.16），12例（80%; 95% CI，55%-93%）达到病毒抑制，另外3例病毒载量下降2-log，中位时间为22天。LAI-ART在高水平物质使用和边缘住房的不同患者群体中的小型示范项目显示了有希望的早期治疗结果，包括那些由于依从性挑战而可检测到病毒血症的患者。需要更多关于LAI-ART在难以接触人群中的数据。我们描述了第一个示范项目的长效注射抗逆转录病毒治疗的人和没有检测到病毒血症的城市人类免疫缺陷病毒诊所，发现有希望的早期治疗结果的人口高水平的物质使用和边缘住房。
Long-acting injectable antiretroviral therapy (LAI-ART) is approved for treatment-naive or experienced people with human immunodeficiency virus (HIV; PWH) based on trials that only included participants with viral suppression. We performed the first LAI-ART demonstration project to include PWH unable to achieve or maintain viral suppression due to challenges adhering to oral ART. Ward 86 is a large HIV clinic in San Francisco that serves publicly insured and underinsured patients. We started patients on LAI-ART via a structured process of provider referral, multidisciplinary review (MD, RN, pharmacist), and monitoring for on-time injections. Inclusion criteria were willingness to receive monthly injections and a reliable contact method. Between June 2021 and April 2022, 51 patients initiated LAI-ART, with 39 receiving at least 2 follow-up injections by database closure (median age, 46 years; 90% cisgender men, 61% non-White, 41% marginally housed, 54% currently using stimulants). Of 24 patients who initiated injections with viral suppression (median CD4 cell count, 706 cells/mm3), 100% (95% confidence interval [CI], 86%–100%) maintained viral suppression. Of 15 patients who initiated injections with detectable viremia (median CD4 cell count, 99 cells/mm3; mean log10 viral load, 4.67; standard deviation, 1.16), 12 (80%; 95% CI, 55%–93%) achieved viral suppression, and the other 3 had a 2-log viral load decline by a median of 22 days. This small demonstration project of LAI-ART in a diverse group of patients with high levels of substance use and marginal housing demonstrated promising early treatment outcomes, including in those with detectable viremia due to adherence challenges. More data on LAI-ART in hard-to-reach populations are needed. We describe the first demonstration project of long-acting injectable antiretroviral therapy in persons with and without detectable viremia in an urban human immunodeficiency virus clinic, finding promising early treatment outcomes in a population with high levels of substance use and marginal housing.
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DOI：
10.1097/qad.0000000000002883
发表时间：
2021-07-15
期刊：
AIDS (London, England)
影响因子：
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作者：
Cutrell AG;Schapiro JM;Perno CF;Kuritzkes DR;Quercia R;Patel P;Polli JW;Dorey D;Wang Y;Wu S;Van Eygen V;Crauwels H;Ford SL;Baker M;Talarico CL;Clair MS;Jeffrey J;White CT;Vanveggel S;Vandermeulen K;Margolis DA;Aboud M;Spreen WR;van Lunzen J
通讯作者：
van Lunzen J
影响因子：
5.9
作者：
Cihlar, Tomas;Fordyce, Marshall
通讯作者：
Fordyce, Marshall
影响因子：
3.2
作者：
Dale, Sannisha K.;Bogart, Laura M.;Klein, David J.
通讯作者：
Klein, David J.
影响因子：
6.4
作者：
Lundgren, Jens D.;Babiker, Abdel;Phillips, Andrew N.
通讯作者：
Phillips, Andrew N.
影响因子：
4.2
作者：
Clemenzi-Allen, Angelo;Geng, Elvin;Gandhi, Monica
通讯作者：
Gandhi, Monica