HIV Viral Suppression Trends Over Time Among HIV-Infected Patients Receiving Care in the United States, 1997 to 2015: A Cohort Study.
HIV Viral Suppression Trends Over Time Among HIV-Infected Patients Receiving Care in the United States, 1997 to 2015: A Cohort Study.
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DOI：
10.7326/m17-2242
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发表时间：
2018-09-18
影响因子：
39.2
通讯作者：
Crane HM
中科院分区：
文献类型：
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作者：
Nance RM;Delaney JAC;Simoni JM;Wilson IB;Mayer KH;Whitney BM;Aunon FM;Safren SA;Mugavero MJ;Mathews WC;Christopoulos KA;Eron JJ;Napravnik S;Moore RD;Rodriguez B;Lau B;Fredericksen RJ;Saag MS;Kitahata MM;Crane HM
由于抑制艾滋病毒对最佳结果和预防工作至关重要，因此了解趋势和预测因素对于公共卫生政策至关重要。评估HIV感染者（PLWH）的病毒抑制趋势，包括相关因素的关系，如人口统计学特征和整合酶链转移抑制剂（ISTI）的使用。纵向观察队列研究。全美共有8家艾滋病诊所。PLWH接受临床护理。为了了解病毒抑制趋势（≤400拷贝/mL），测定了1997 - 2015年的年病毒抑制率。重复分析，每人每年进行1次随机测试，并使用反向概率审查权重以解决随访损失。使用联合纵向和生存模型以及接受抗逆转录病毒治疗（ART）的PLWH的线性混合模型来检查病毒抑制或持续病毒载量（VL）水平与人口统计学因素、药物使用、依从性和ISTI使用之间的关系。在31330名PLWH的所有检测中，病毒抑制率从1997年的32%上升到2015年的86%。在校正分析中，年龄较大（比值比[OR]， 0.76 / 10年[95% CI， 0.74 - 0.78]）和使用基于isi的方案（OR, 0.54 [CI, 0.51 - 0.57]）与可检测到VL的几率较低相关，黑人种族与较高的几率相关（OR, 1.68 [CI, 1.57 - 1.80]）（各P < 0.001）。连续VL水平也出现了类似的模式；当分析仅限于2010年至2015年；并根据依从性，药物使用或抑郁症进行调整。结果仅限于接受临床护理的PLWH。在美国，HIV病毒抑制率显著提高，这可能部分归功于抗逆转录病毒治疗的改进，包括基于sti的治疗方案。然而，年轻和黑人PLWH之间的差异值得注意。
Because HIV viral suppression is essential for optimal outcomes and prevention efforts, understanding trends and predictors is imperative to inform public health policy. To evaluate viral suppression trends in people living with HIV (PLWH), including the relationship of associated factors, such as demographic characteristics and integrase strand transfer inhibitor (ISTI) use. Longitudinal observational cohort study. 8 HIV clinics across the United States. PLWH receiving clinical care. To understand trends in viral suppression (≤400 copies/mL), annual viral suppression rates from 1997 to 2015 were determined. Analyses were repeated with tests limited to 1 random test per person per year and using inverse probability of censoring weights to address loss to follow-up. Joint longitudinal and survival models and linear mixed models of PLWH receiving antiretroviral therapy (ART) were used to examine associations between viral suppression or continuous viral load (VL) levels and demographic factors, substance use, adherence, and ISTI use. Viral suppression increased from 32% in 1997 to 86% in 2015 on the basis of all tests among 31 930 PLWH. In adjusted analyses, being older (odds ratio [OR], 0.76 per decade [95% CI, 0.74 to 0.78]) and using an ISTI-based regimen (OR, 0.54 [CI, 0.51 to 0.57]) were associated with lower odds of having a detectable VL, and black race was associated with higher odds (OR, 1.68 [CI, 1.57 to 1.80]) (P < 0.001 for each). Similar patterns were seen with continuous VL levels; when analyses were limited to 2010 to 2015; and with adjustment for adherence, substance use, or depression. Results are limited to PLWH receiving clinical care. HIV viral suppression rates have improved dramatically across the United States, which is likely partially attributable to improved ART, including ISTI-based regimens. However, disparities among younger and black PLWH merit attention.