Disengagement From HIV Care and Failure of Second-Line Therapy in Nigeria: A Retrospective Cohort Study, 2005-2017.
Disengagement From HIV Care and Failure of Second-Line Therapy in Nigeria: A Retrospective Cohort Study, 2005-2017.
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DOI：
10.1097/qai.0000000000002918
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发表时间：
2022-05-01
期刊：
影响因子：
--
通讯作者：
Sabin CA
中科院分区：
文献类型：
--
作者：
El Bouzidi K;Murtala-Ibrahim F;Kwaghe V;Datir RP;Ogbanufe O;Crowell TA;Charurat M;Dakum P;Gupta RK;Ndembi N;Sabin CA
了解在二线抗逆转录病毒治疗（ART）期间脱离艾滋病毒护理和治疗失败的相关性可以为干预措施提供信息，以改善艾滋病毒感染者（PLHIV）的临床结果。我们对2005年至2017年期间在尼日利亚一家高等教育中心开始二线抗逆转录病毒治疗的年龄在50至15岁的艾滋病毒感染者进行了回顾性队列研究。如果参与者在每次诊所访问后一年内没有返回，则认为他们已经脱离了护理。使用Cox比例风险模型来研究以下因素的相关性：i)病毒衰竭（HIV-1 RNA >0 000拷贝/mL）， ii)免疫功能衰竭（CD4计数减少或<100个细胞/mm3）， iii)在接受二线抗逆转录病毒治疗6个月后体重严重下降（>为体重的10%）。在1031名参与者中，33%（341人）在中位随访6.9年（IQR 3.7-8.5）期间脱离了护理。其中26%（89/341）随后重新进入护理。在二线抗逆转录病毒治疗开始时，脱离治疗与男性、年龄<30岁、低教育水平和低CD4计数有关。在终点评估可用的参与者中，20%（112/565）出现病毒衰竭，32%（257/809）出现免疫功能衰竭，23%（190/831）出现体重减轻。与初级职业相比，专业职业的病毒衰竭风险较低：校正风险比为0.17（95%可信区间为0.04-0.70）。不良后果在二线抗逆转录病毒治疗期间很常见。然而，重新参与是可能的，应该分配资源，重点放在将艾滋病毒感染者留在护理中，并提供服务，追踪和重新参与那些脱离护理的人。
Understanding the correlates of disengagement from HIV care and treatment failure during second-line antiretroviral therapy (ART) could inform interventions to improve clinical outcomes among people living with HIV (PLHIV). We conducted a retrospective cohort study of PLHIV aged >15 years who started second-line ART at a tertiary centre in Nigeria between 2005 and 2017. Participants were considered to have disengaged from care if they had not returned within a year after each clinic visit. Cox proportional hazards models were used to investigate factors associated with: i) viral failure (HIV-1 RNA >1,000 copies/mL), ii) immunologic failure (CD4 count decrease or <100 cells/mm3), and iii) severe weight loss (>10% of bodyweight), after >6 months of second-line ART. Among 1031 participants, 33% (341) disengaged from care during a median follow-up of 6.9 years (IQR 3.7–8.5). Of these, 26% (89/341) subsequently re-entered care. Disengagement was associated with male gender, age <30, lower education level and low CD4 count at second-line ART initiation. Among participants with endpoint assessments available, 20% (112/565) experienced viral failure, 32% (257/809) experienced immunologic failure, and 23% (190/831) experienced weight loss. A lower risk of viral failure was associated with professional occupations compared to elementary: adjusted hazard ratio 0.17 (95% confidence interval 0.04–0.70). Adverse outcomes were common during second-line ART. However, re-engagement is possible and resources should be allocated to focus on retaining PLHIV in care and providing services to trace and re-engage those who have disengaged from care.
影响因子：
2.2
作者：
Ndembi N;Murtala-Ibrahim F;Tola M;Jumare J;Aliyu A;Alabi P;Mensah C;Abimiku A;Quiñones-Mateu ME;Crowell TA;Rhee SY;Shafer RW;Gupta R;Blattner W;Charurat ME;Dakum P
通讯作者：
Dakum P
影响因子：
2.9
作者：
Gesesew HA;Ward P;Woldemichael K;Mwanri L
通讯作者：
Mwanri L