Time spent with HIV-RNA ≤ 200 copies/ml in a cohort of people with HIV during the U=U era.
Time spent with HIV-RNA ≤ 200 copies/ml in a cohort of people with HIV during the U=U era.
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DOI：
10.1097/qad.0000000000002825
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发表时间：
2021-06-01
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观察性研究发现，当感染艾滋病毒的伴侣的病毒载量低于200DNA拷贝/毫升(U状态)时，在血清不一致的夫妇中，艾滋病毒关联传播的风险为零。我们的目标是估计保持“U状态”的时间比例，并确定与失去它的风险相关的因素。观察性队列研究。我们纳入了Icona队列中的参与者，他们在2010年12月达到了已确定的“U状态”(病毒载量≤为200 拷贝/毫升，持续6个 月)。研究结果是病毒载量超过200kb 拷贝/毫升以上的随访人天数与观察到的随访人天数之比。Logistic回归模型被用来确定与失去U状态的风险独立相关的因素。8,241名艾滋病毒携带者被纳入分析，他们贡献了2个 670个 888个PDFU。其中，1648人(20%)是女性，768人(9%)是注射毒品者(PWID)，2066人(25%)是外国出生的。病毒载量测量的中位数为9(IQR：4-15)。总体而言，当病毒载量大于2 0 0 拷贝/ml时，仅有3.1%的PDFU被观察到，而病毒载量大于2 0 0 拷贝/ml的PDFU的比例高于女性(5.3%)、失业者(5.4%)、慢性阻塞性肺疾病(4.7%)和有3次以上病毒学失败史的人(6.3%)。在多变量Logistic回归中，这些变量是失去“U状态”的显著预测因素。我们的结果加强了U=U消息在现实世界中的有效性。然而，我们确定了我们的研究人群中有更高风险失去U状态的亚群，这需要更多的努力。
Zero risk of linked HIV transmission in serodiscordant couples when the HIV-infected partner had viral load less than 200 copies/ml (‘U status’) was found in observational studies. We aimed at estimating the proportion of time in which ‘U status’ was maintained and identifying factors associated with the risk of losing it. Observational cohort study. We included participants in the ICONA cohort who had reached an established ‘U status’ (viral load ≤200 copies/ml for >6 months) as of December 2010. The outcome was the number of person-days of follow-up (PDFU) above a viral load greater than 200 copies/ml, relative to the total number of PDFU observed. A logistic regression model was used to identify factors independently associated with the risk of losing ‘U status’. Eight thousand, two hundred and forty-one persons living with HIV were included in the analysis who contributed 2 670 888 PDFU. Of these, 1648 (20%) were women, 768 (9%) were people who inject drugs (PWID), and 2066 (25%) were foreign-born. The median of viral load measurements was 9 (IQR: 4–15). Overall, only 3.1% of PDFU were observed when viral load was above 200 copies/ml. The proportion of PDFU with viral load more than 200 copies/ml was higher than average in women (5.3%), unemployed (5.4%), PWID (4.7%), and in people with more than three previous virologic failures (6.3%). These variables were significant predictors of losing ‘U status’ in the multivariable logistic regression. Our results reinforce the validity of the U=U message in real-world setting. However, we identified subsets of our study population at higher risk of losing the ‘U status’ for whom additional efforts are needed.