Association of highly active antiretroviral therapy coverage, population viral load, and yearly new HIV diagnoses in British Columbia, Canada: a population-based study.
Association of highly active antiretroviral therapy coverage, population viral load, and yearly new HIV diagnoses in British Columbia, Canada: a population-based study.
复制标题
DOI：
10.1016/s0140-6736(10)60936-1
复制
发表时间：
2010-08-14
期刊：
影响因子：
168.9
通讯作者：
Kendall, Peny
中科院分区：
文献类型：
--
作者：
Montaner, Julio S. G.;Lima, Viviane D.;Barrios, Rolando;Yip, Benita;Wood, Evan;Kerr, Thomas;Shannon, Kate;Harrigan, P. Richard;Hogg, Robert S.;Daly, Patricia;Kendall, Peny
队列研究和数学模型表明，扩大高效抗逆转录病毒疗法（HAART）的覆盖范围可以减少艾滋病毒的传播。本研究重点关注加拿大不列颠哥伦比亚省按注射毒品使用分层的艾滋病毒流行情况，并试图估计血浆HIV-1病毒载量、HAART覆盖率和新增艾滋病毒病例数量之间的关联。人口水平。HAART的使用、血浆HIV-1病毒水平测定以及可报告的性传播感染（包括HIV）的发生率都记录在全省范围的登记处，以便对这些参数进行时间比较。新的HIV阳性检测和HAART个体数的趋势采用广义加性模型建模。Poisson对数线性回归模型用于估计新HIV阳性检测结果（每100人）和协变量病毒载量（log 10转换）、年份和HAART个体数之间的相关性。我们的研究结果表明，在人口水平上，HAART覆盖率的增加，病毒载量的减少和每年新的艾滋病毒诊断的减少之间有很强的关联，而艾滋病毒检测的增加和该省其他性传播感染率的增加是一个背景。我们的研究结果支持HAART在当前医疗指南中使用的建议的次要益处，即在人群水平上对HIV传播的益处。
Cohort studies and mathematical models have suggested that expanded coverage with highly active antiretroviral therapy (HAART) could decrease HIV transmission. This study focuses on the HIV epidemic, stratified by injection drug use, in the province of British Columbia, Canada, and seeks to estimate the association between plasma HIV-1-viral load, HAART coverage and number of new cases of HIV at the population-level. HAART use, plasma HIV-1-viral level determinations, and rates of reportable sexually transmitted infections, including HIV, are all recorded in province-wide registries allowing for temporal comparisons of these parameters. Trends of new HIV positive tests and number of individuals on HAART were modeled using generalized additive models. Poisson log-linear regression models were used to estimate the association between the outcome new HIV positive tests (per 100 population) and the covariates viral load (log10 transformed), year, and number of individuals on HAART. Our results demonstrate a strong association at the population-level between increasing levels of HAART coverage, decreased viral load and decreased new HIV diagnoses/year, against a background of increased HIV testing and increased rates of other STIs in the province. Our results support the proposed secondary benefit of HAART, used within current medical guidelines, on HIV transmission at a population level.