Trends in Time From HIV Diagnosis to First Viral Suppression Following Revised US HIV Treatment Guidelines, 2012-2017.
Trends in Time From HIV Diagnosis to First Viral Suppression Following Revised US HIV Treatment Guidelines, 2012-2017.
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DOI：
10.1097/qai.0000000000002398
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发表时间：
2020-09-01
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自2012年以来，治疗指南建议在艾滋病毒诊断后尽快开始对所有人进行抗逆转录病毒治疗，无论CD 4计数如何。如果临床医生采用治疗指南，预计诊断和首次病毒抑制（Dx至VS）之间的间隔会缩短，诊断时CD 4计数≥500个细胞/μL的患者下降幅度更大。使用国家艾滋病监测系统数据，我们检查了2012-2017年期间诊断为艾滋病毒感染的≥13岁人群的Dx至VS间隔。分析按首次CD 4计数分层：CD 4 ≥500个细胞/μL，200-499个细胞/μL，<200个细胞/μL，诊断后3个月内未报告CD 4值。在2012-2017年期间，在27个美国司法管辖区，有完整的实验室报告，发生了138，759例艾滋病毒诊断。与2017年相比，2012年诊断的HIV感染者的Dx至VS间期中位数从9个月缩短至5个月，年下降12.3%（P < 0.001），所有CD 4组均如此。2012年，CD 4 ≥500个细胞/μL的患者的Dx至VS间期长于200-499个细胞/μL和<200个细胞/μL的患者（中位数分别为9、7和6个月）。到2017年，这些群体的中位间隔为4个月，而诊断后3个月内没有CD 4值的群体为25个月。所有CD 4组的Dx至VS间期均缩短，其中CD 4 ≥500个细胞/μL组的缩短幅度更大，这与治疗建议的实施一致。在诊断后3个月内与护理无关的人中，Dx到VS的间隔时间最长，这强调了解决与护理联系障碍以结束艾滋病毒流行的重要性。
Since 2012, treatment guidelines have recommended initiating antiretroviral therapy for all persons as soon as possible after HIV diagnosis, irrespective of CD4 counts. If clinicians adopted the treatment guidelines, a shortened interval between diagnosis and first viral suppression (Dx-to-VS) would be expected, with greater declines among those with CD4 counts ≥500 cells/μL at diagnosis. Using the National HIV Surveillance System data, we examined Dx-to-VS intervals among persons aged ≥13 years with HIV infection diagnosed during 2012–2017. Analyses were stratified by the first CD4 count: CD4 ≥500 cells/μL, 200–499 cells/μL, <200 cells/μL, and no CD4 value reported within 3 months after diagnosis. During 2012–2017 in the 27 US jurisdictions with complete laboratory reporting, 138,759 HIV diagnoses occurred. The median Dx-to-VS interval shortened overall for persons with HIV diagnosed in 2012 vs. 2017 from 9 to 5 months, a 12.3% annual decrease (P < 0.001) and in all CD4 groups. In 2012, the Dx-to-VS interval was longer for persons with CD4 ≥500 cells/μL than 200–499 cells/μL and <200 cells/μL (median, 9, 7, and 6 months, respectively). By 2017, the median interval was 4 months for these groups, compared with 25 months for those without a CD4 value within 3 months after diagnosis. Decreases in Dx-to-VS intervals across all CD4 groups with a greater decrease among those with CD4 ≥500 cells/μL are consistent with the implementation of treatment recommendations. The Dx-to-VS interval was longest among persons not linked to care within 3 months after diagnosis, underscoring the importance of addressing barriers to linkage to care for ending the HIV epidemic.