Novel use of surveillance data to detect HIV-infected persons with sustained high viral load and durable virologic suppression in New York City.
Novel use of surveillance data to detect HIV-infected persons with sustained high viral load and durable virologic suppression in New York City.
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DOI：
10.1371/journal.pone.0029679
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发表时间：
2012
期刊：
影响因子：
3.7
通讯作者：
Shepard CW
中科院分区：
文献类型：
--
作者：
Terzian AS;Bodach SD;Wiewel EW;Sepkowitz K;Bernard MA;Braunstein SL;Shepard CW
监测人群中ART的吸收和疗效往往依赖于横断面数据，提供有限的信息，可用于设计特定的有针对性的干预计划。利用病毒载量（VL）监测数据的重复测量，我们旨在估计和描述纽约市（NYC）持续高VL（SHVL）和持久抑制VL（DSVL）的HIV/AIDS（PLWHA）感染者的比例。回顾性队列研究，对2005年底前向纽约市艾滋病毒监测登记处报告的所有存活且≥12岁且在2006年和2007年接受≥2次VL检测的患者进行。SHVL和DSVL分别定义为连续2个VL ≥ 100，000拷贝/mL的PLWHA和所有VL ≤400拷贝/mL的PLWHA。使用广义估计方程的Logistic回归模型对SHVL和协变量之间的关联进行建模。有56 836名艾滋病毒/艾滋病感染者，其中7%患有SHVL，38%患有DSVL。与那些没有SHVL的人相比，SHVL患者更可能是年轻人，黑人和有注射毒品（IDU）的风险。到2007年，患有SHVL的艾滋病毒携带者/艾滋病患者死亡的可能性更大，平均年轻近10岁。2005年，近60%的艾滋病毒/艾滋病感染者有多种VL，其中近40%有DSVL，这表明抗逆转录病毒疗法获得成功。一小部分人患有SHVL，代表已知在护理中参与度不佳的群体。应针对这一群体开展更多的外联活动，以减少发病率和二次传播。基于监测数据的纵向分析的措施，结合横断面措施，如社区病毒载量，是监测抗逆转录病毒治疗有效性和对疾病传播的潜在影响比单独的横断面措施更精确和强大的工具。
Monitoring of the uptake and efficacy of ART in a population often relies on cross-sectional data, providing limited information that could be used to design specific targeted intervention programs. Using repeated measures of viral load (VL) surveillance data, we aimed to estimate and characterize the proportion of persons living with HIV/AIDS (PLWHA) in New York City (NYC) with sustained high VL (SHVL) and durably suppressed VL (DSVL). Retrospective cohort study of all persons reported to the NYC HIV Surveillance Registry who were alive and ≥12 years old by the end of 2005 and who had ≥2 VL tests in 2006 and 2007. SHVL and DSVL were defined as PLWHA with 2 consecutive VLs ≥100,000 copies/mL and PLWHA with all VLs ≤400 copies/mL, respectively. Logistic regression models using generalized estimating equations were used to model the association between SHVL and covariates. There were 56,836 PLWHA, of whom 7% had SHVL and 38% had DSVL. Compared to those without SHVL, persons with SHVL were more likely to be younger, black and have injection drug use (IDU) risk. PLWHA with SHVL were more likely to die by 2007 and be younger by nearly ten years, on average. Nearly 60% of PLWHA in 2005 had multiple VLs, of whom almost 40% had DSVL, suggesting successful ART uptake. A small proportion had SHVL, representing groups known to have suboptimal engagement in care. This group should be targeted for additional outreach to reduce morbidity and secondary transmission. Measures based on longitudinal analyses of surveillance data in conjunction with cross-sectional measures such as community viral load represent more precise and powerful tools for monitoring ART effectiveness and potential impact on disease transmission than cross-sectional measures alone.
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影响因子：
2.1
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