Results of Early Virologic Monitoring May Facilitate Differentiated Care Monitoring Strategies for Clients on ART, Rakai, Uganda.
Results of Early Virologic Monitoring May Facilitate Differentiated Care Monitoring Strategies for Clients on ART, Rakai, Uganda.
复制标题
早期病毒学监测结果可能有助于为 ART 客户制定差异化护理监测策略，乌干达拉凯。
DOI：
10.1093/ofid/ofy212
复制
发表时间：
2018
影响因子：
4.2
通讯作者：
Reynolds,StevenJ
中科院分区：
文献类型：
--
作者：
Ssempijja,Victor;Chang,LarryW;Nakigozi,Gertrude;Ndyanabo,Anthony;Quinn,ThomasC;Cobelens,Frank;Wawer,Maria;Gray,Ronald;Serwadda,David;Reynolds,StevenJ
背景病毒载量（VL）监测是开始抗逆转录病毒治疗（ART）的hiv感染者的标准护理。我们评估了在开始一线抗逆转录病毒治疗后6个月和12个月VL测量的预测价值，以估计未来病毒学失败（VF）的风险。方法根据世界卫生组织指南，评估在抗逆转录病毒治疗开始后6个月和12个月进行VL测量并在此后至少进行2次VL测量的hiv感染者未来VF的风险。art后6、12个月的VL分为<400、400 - 1000、1001-2000和bb0 2000拷贝/mL。采用Cox比例风险模型比较与6个月、12个月以及6个月和12个月VL预测指标相关的VF发生率。结果1863例hiv感染成人在6个月和12个月进行了VL测量，1588例至少增加了2个VL，用于预测未来的VF。大多数（67%）为女性（中位年龄：女性33岁，男性37岁）。在art治疗后12个月，90%的VL<400拷贝/mL (VF累计发生率为1.5%)，3%的VF为400 - 1000拷贝/mL (VF 12%)， 2%的VF为1001-2000拷贝/mL (VF 22%)， 5%的VF为1000拷贝/mL （VF 71%）。12个月VL测量的预测价值与6个月和12个月VL测量的综合预测价值相当，且优于6个月VL测量。结论在抗逆转录病毒治疗开始12个月后，90%的患者病毒被抑制，未来发生VF的可能性较低。抗逆转录病毒治疗开始后12个月的VL测量可预测VF的风险，并可为区分病毒学监测策略提供信息。
BackgroundViral load (VL) monitoring is standard of care in HIV-infected persons initiated on antiretroviral therapy (ART). We evaluated the predictive value of VL measurements at 6 and 12 months after initiation of firstline ART to estimate the future risk of virologic failure (VF).MethodsHIV-infected persons with VL measurements at 6 and 12 months post-ART initiation and at least 2 additional VL measurements thereafter were assessed for risk of future VF, defined per World Health Organization guidelines. VL at 6 or 12 months post-ART was categorized into <400, 400–1000, 1001–2000, and >2000 copies/mL. Cox proportional hazard models were used to compare VF incidence associated with 6-month, 12-month, and a composite of 6- and 12-month VL prediction indicators.ResultsOverall, 1863 HIV-infected adults had a 6- and 12-month VL measurement, and 1588 had at least 2 additional VLs thereafter for predicting future VF. The majority (67%) were female (median age: females 33 years and males 37 years). At 12 months post-ART, 90% had VL<400 copies/mL (cumulative incidence of VF at 1.5%), 3% had 400–1000 copies/mL (VF 12%), 2% had 1001–2000 copies/mL (VF 22%), and 5% had >2000 copies/mL (VF 71%). The predictive value of the 12-month VL measurement was comparable to the composite of both the 6- and 12-month VL measurements and better than the 6-month VL measurement.ConclusionsAt 12 months after ART initiation, 90% of patients were virally suppressed with a low likelihood of future VF. VL measurement at 12 months post–ART initiation predicts risk of VF and could inform differentiated virologic monitoring strategies.