Disparities in antiretroviral treatment: a comparison of behaviorally HIV-infected youth and adults in the HIV Research Network.
Disparities in antiretroviral treatment: a comparison of behaviorally HIV-infected youth and adults in the HIV Research Network.
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DOI：
10.1097/qai.0b013e31822327df
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发表时间：
2011-09-01
期刊：
影响因子：
--
通讯作者：
HIV Research Network
中科院分区：
文献类型：
--
作者：
Agwu AL;Fleishman JA;Korthuis PT;Siberry GK;Ellen JM;Gaur AH;Rutstein R;Gebo KA;HIV Research Network
越来越多的年轻人感染艾滋病毒，需要高效抗逆转录病毒疗法(HAART)。我们假设，18-24岁的行为艾滋病毒感染青年(BIY)比成年人(≥，25岁)接受HAART的可能性较小，一旦开始，更有可能停止他们的第一个HAART方案。治疗的纵向分析--符合HAART标准的天真患者(≥，18岁)，并在艾滋病毒感染部位进行了随访(2002年至2008年)。用COX比例风险回归法评估从达到标准到HAART开始的时间和第一次方案的持续时间。3,127(268名青年，2,859名成人)治疗--幼稚的艾滋病毒感染患者符合标准。与25岁的成年人≥相比，BY更有可能是黑人(66.8%比51.1%；P<；.01)，并且不太可能识别注射毒品使用艾滋病毒的风险(1.1%比8.8%；P<；.01)。近69%的BIY开始了HAART，相比之下，79%的成年人开始了HAART；25-29岁(调整后危险比1.39[95%可信区间：1.12-1.73])和≥50(调整后危险比1.24[95%可信区间1.00-1.54])，而不是30-49岁(调整后危险比1.19[95%可信区间0.99-1.44])比BIY更有可能引发HAART。在符合标准的一年内参加≥4艾滋病毒提供者访问与启动HAART相关(AHR1.91[1.70-2.14])。CD4200-350与200cell/mm3(AHR 0.57(95%CI 0.52-0.63))和IDU(AHR 0.80[95%CI 0.69-0.92])与HAART启动的可能性较低相关。在第一次方案的持续时间上没有年龄相关的差异。BY在达到治疗标准时不太可能开始HAART。解决与这一差距有关的因素对于改善对青年的关怀至关重要。
Increasing numbers of youth are becoming HIV-infected and need highly active antiretroviral therapy (HAART). We hypothesized that behaviorally HIV-infected youth (BIY) ages 18–24 are less likely than adults (≥25 years) to receive HAART and once initiated, more likely to discontinue their first HAART regimen. Longitudinal analysis of treatment-naïve patients (age ≥18) meeting criteria for HAART and followed at HIVRN sites (2002–2008). Time from meeting criteria to HAART initiation and duration on first regimen were assessed using Cox proportional hazards regression. 3,127 (268 youth, 2,859 adult) treatment-naïve, HIV-infected patients met criteria. BIY were more likely to be Black (66.8% vs. 51.1%; p<.01) and less likely to identify injection drug use (IDU) HIV risk (1.1% vs. 8.8%; p<.01) than adults ≥ 25 years. Nearly 69% of BIY started HAART, versus 79% of adults; p<.001. Adults 25–29 (Adjusted Hazards Ratio (AHR) 1.39 [95% CI: 1.12–1.73]) and ≥50 (AHR 1.24 [95% CI 1.00–1.54]), but not 30–49 years (AHR 1.19 [95% CI 0.99–1.44]) were more likely to initiate HAART than BIY. Attending ≥4 HIV provider visits within one year of meeting criteria was associated with HAART initiation (AHR 1.91 [1.70–2.14]). CD4 200–350 vs. <200 cells/mm3 (AHR 0.57 (95% CI 0.52–0.63]) and IDU (AHR 0.80 [95% CI 0.69–0.92]) were associated with a lower likelihood of HAART initiation. There were no age-related differences in duration of first regimen. BIY are less likely to start HAART when meeting treatment criteria. Addressing factors associated with this disparity is critical to improving care for youth.