Effectiveness of first-line antiretroviral therapy in the IPEC cohort, Rio de Janeiro, Brazil.
Effectiveness of first-line antiretroviral therapy in the IPEC cohort, Rio de Janeiro, Brazil.
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DOI：
10.1186/1742-6405-11-29
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发表时间：
2014
影响因子：
2.2
通讯作者：
Grinsztejn B
中科院分区：
文献类型：
--
作者：
Cardoso SW;Luz PM;Velasque L;Torres T;Coelho L;Freedberg KA;Veloso VG;Walensky RP;Grinsztejn B
虽然巴西有一项长期的政策，为所有有需要的人免费提供抗逆转录病毒疗法，但在这个中等收入国家，抗逆转录病毒疗法对人类免疫缺陷病毒RNA抑制的流行病学影响尚未得到很好的评价。我们在一个大型巴西队列中评估一线ART的有效性，并研究与病毒学抑制相关的社会人口统计学、行为学、临床和结构因素。在ART开始后6、12和24个月时一线ART的病毒学抑制定义为病毒载量测量值≤400拷贝/mL，且未进行药物类别调整和/或停药。根据特定药物的类别定义药物类别调整和/或停药。拟泊松回归用于量化因子与病毒学抑制的相关性。从2000年1月至2010年6月，1311例患者开始一线ART治疗; 987例（75%）患者使用基于NNRTI的方案。在6、12和24个月时，分别有77%、76%和68%的患者实现了病毒学抑制。12个月时与病毒学抑制相关的因素包括：>8年正规教育（与<4年相比，风险比（RR）1.13，95%置信区间（95% CI）1.03-1.24），2005-2010年开始抗逆转录病毒治疗（与2000-2004年相比，RR 1.25 95% CI 1.15-1.35）和临床试验参与（与未参与相比，RR 1.08 95% CI 1.01-1.16）。同样在12个月时，与异性恋男性相比，女性表现出较少的病毒学抑制（RR 0.90 95% CI 0.82-0.99）。对于24个月的终点，除了高等教育，在后期开始ART和临床试验参与，年龄较大和基于NNRTI的方案也与病毒学抑制独立相关。我们的研究结果显示，在巴西这个可免费获得治疗的中等收入国家，超过四分之三接受常规治疗的患者在第一年年底达到了一线ART的病毒学抑制。高等教育，最近开始的ART和临床试验参与与12个月和24个月终点的改善结果相关，这表明需要进一步研究以了解与这些因素相关的哪些方面导致更高的病毒学抑制。
While Brazil has had a long-standing policy of free access to antiretroviral therapy (ART) for all in need, the epidemiological impact of ART on human immunodeficiency virus (HIV) RNA suppression in this middle-income country has not been well evaluated. We estimate first-line ART effectiveness in a large Brazilian cohort and examine the socio-demographic, behavioral, clinical and structural factors associated with virologic suppression. Virologic suppression on first-line ART at 6, 12, and 24 months from start of ART was defined as having a viral load measurement ≤400 copies/mL without drug class modification and/or discontinuation. Drug class modification and/or discontinuation were defined based on the class of a particular drug. Quasi-Poisson regression was used to quantify the association of factors with virologic suppression. From January 2000 through June 2010, 1311 patients started first-line ART; 987 (75%) patients used NNRTI-based regimens. Virologic suppression was achieved by 77%, 76% and 68% of patients at 6, 12 and 24 months, respectively. Factors associated with virologic suppression at 12 months were: >8 years of formal education (compared to <4 years, risk ratio (RR) 1.13, 95% confidence interval (95% CI) 1.03-1.24), starting ART in 2005-2010 (compared to 2000-2004, RR 1.25 95% CI 1.15-1.35), and clinical trial participation (compared to no participation, RR 1.08 95% CI 1.01-1.16). Also at 12 months, women showed less virologic suppression compared to heterosexual men (RR 0.90 95% CI 0.82-0.99). For the 24-month endpoint, in addition to higher education, starting ART in the later period, and clinical trial participation, older age and an NNRTI-based regimen were also independently associated with virologic suppression. Our results show that in Brazil, a middle-income country with free access to treatment, over three-quarters of patients receiving routine care reached virologic suppression on first-line ART by the end of the first year. Higher education, more recent ART initiation and clinical trial participation were associated with improved outcomes both for the 12-month and the 24-month endpoints, suggesting that further studies are needed to understand what aspects relating to these factors lead to higher virologic suppression.
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影响因子：
3.8
作者：
Campos, DP;Ribeiro, SR;Gadelha, AJ
通讯作者：
Gadelha, AJ
影响因子：
11.8
作者：
Ivers, LC;Kendrick, D;Doucette, K
通讯作者：
Doucette, K
影响因子：
--
作者：
Elzi, Luigia;Erb, Stefan;Battegay, Manuel
通讯作者：
Battegay, Manuel
DOI：
10.1097/qai.0b013e31802c7e20
发表时间：
2007-03-01
影响因子：
3.6
作者：
Bosch, Ronald J.;Bennett, Kara;Benson, Constance A.
通讯作者：
Benson, Constance A.
影响因子：
2.2
作者：
Marconi, Vincent C.;Grandits, Greg A.;Agan, Brian K.
通讯作者：
Agan, Brian K.