Prevalence of nonsuppressed viral load and associated factors among HIV-positive adults receiving antiretroviral therapy in Eswatini, Lesotho, Malawi, Zambia and Zimbabwe (2015 to 2017): results from population-based nationally representative surveys.
Prevalence of nonsuppressed viral load and associated factors among HIV-positive adults receiving antiretroviral therapy in Eswatini, Lesotho, Malawi, Zambia and Zimbabwe (2015 to 2017): results from population-based nationally representative surveys.
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DOI：
10.1002/jia2.25631
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发表时间：
2020-11
影响因子：
6
通讯作者：
Justman JE
中科院分区：
文献类型：
--
作者：
Haas AD;Radin E;Hakim AJ;Jahn A;Philip NM;Jonnalagadda S;Saito S;Low A;Patel H;Schwitters AM;Rogers JH;Frederix K;Kim E;Bello G;Williams DB;Parekh B;Sachathep K;Barradas DT;Kalua T;Birhanu S;Musuka G;Mugurungi O;Tippett Barr BA;Sleeman K;Mulenga LB;Thin K;Ao TT;Brown K;Voetsch AC;Justman JE
2020年的全球目标是，≥90%接受抗逆转录病毒治疗（ART）的HIV感染者将实现病毒载量抑制（VLS）。我们在接受ART至少4个月的成年人中研究了VLS及其决定因素。我们分析了在斯威士兰、莱索托、马拉维、赞比亚和津巴布韦（2015年至2017年）进行的基于人口的艾滋病毒影响评估（PHIA）调查的数据。PHIA调查是具有全国代表性的横断面家庭调查。数据收集包括结构化访谈、家庭艾滋病毒检测和实验室检测。对艾滋病毒感染者的血液样本进行了艾滋病毒RNA、CD 4计数和近期抗逆转录病毒药物暴露情况的分析。我们计算了VLS患病率的代表性估计值（病毒载量<1000拷贝/mL），非抑制病毒载量（NVL;病毒载量≥1000拷贝/mL），病毒学失败（VF;存在抗逆转录病毒药物且病毒载量≥1000拷贝/mL），间断ART（不存在抗逆转录病毒药物且病毒载量≥1000拷贝/mL）和转换为二线抗逆转录病毒药物的比率在斯威士兰、莱索托、马拉维、赞比亚和津巴布韦参加PHIA调查的15至59岁艾滋病毒感染者中，在调查前至少4个月开始ART，并且在调查时正在接受ART（根据自我报告或ARV检测）。我们计算了与NVL、VF、中断ART和转换为二线ART相关因素的比值比和发生率比。我们纳入了9200名接受ART的成人，其中88.8%患有VLS，11.2%患有NVL，包括8.2%经历VF和3.0%中断ART。年龄较小、男性、教育程度较低、依从性不佳、接受奈韦拉平、HIV未公开、从未结婚并居住在津巴布韦，莱索托或赞比亚的人与NVL的几率较高有关。在NVL患者中，婚姻、女性性别、较短的ART持续时间、较高的CD 4计数和饮酒与VF的几率较低和中断ART的几率较高相关。许多VF患者（44.8%）的CD 4计数<200个细胞/微升，但很少（每年0.31%）转为二线ART。各国正在接近成人的全球VLS目标。治疗支持，特别是对年轻人和CD 4计数较高的人，以及转换为基于蛋白酶抑制剂或整合酶抑制剂的治疗方案可能会进一步降低NVL的患病率。
The global target for 2020 is that ≥90% of people living with HIV (PLHIV) receiving antiretroviral therapy (ART) will achieve viral load suppression (VLS). We examined VLS and its determinants among adults receiving ART for at least four months. We analysed data from the population‐based HIV impact assessment (PHIA) surveys in Eswatini, Lesotho, Malawi, Zambia and Zimbabwe (2015 to 2017). PHIA surveys are nationally representative, cross‐sectional household surveys. Data collection included structured interviews, home‐based HIV testing and laboratory testing. Blood samples from PLHIV were analysed for HIV RNA, CD4 counts and recent exposure to antiretroviral drugs (ARVs). We calculated representative estimates for the prevalence of VLS (viral load <1000 copies/mL), nonsuppressed viral load (NVL; viral load ≥1000 copies/mL), virologic failure (VF; ARVs present and viral load ≥1000 copies/mL), interrupted ART (ARVs absent and viral load ≥1000 copies/mL) and rates of switching to second‐line ART (protease inhibitors present) among PLHIV aged 15 to 59 years who participated in the PHIA surveys in Eswatini, Lesotho, Malawi, Zambia and Zimbabwe, initiated ART at least four months before the survey and were receiving ART at the time of the survey (according to self‐report or ARV testing). We calculated odds ratios and incidence rate ratios for factors associated with NVL, VF, interrupted ART, and switching to second‐line ART. We included 9200 adults receiving ART of whom 88.8% had VLS and 11.2% had NVL including 8.2% who experienced VF and 3.0% who interrupted ART. Younger age, male sex, less education, suboptimal adherence, receiving nevirapine, HIV non‐disclosure, never having married and residing in Zimbabwe, Lesotho or Zambia were associated with higher odds of NVL. Among people with NVL, marriage, female sex, shorter ART duration, higher CD4 count and alcohol use were associated with lower odds for VF and higher odds for interrupted ART. Many people with VF (44.8%) had CD4 counts <200 cells/µL, but few (0.31% per year) switched to second‐line ART. Countries are approaching global VLS targets for adults. Treatment support, in particular for younger adults, and people with higher CD4 counts, and switching of people to protease inhibitor‐ or integrase inhibitor‐based regimens may further reduce NVL prevalence.
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影响因子：
3.7
作者：
Kyaw NT;Harries AD;Kumar AM;Oo MM;Kyaw KW;Win T;Aung TK;Min AC;Oo HN
通讯作者：
Oo HN
DOI：
10.1093/cid/ciy347
发表时间：
2018-11-13
期刊：
Clinical infectious diseases : an official publication of the Infectious Diseases Society of America
影响因子：
--
作者：
Chammartin F;Zürcher K;Keiser O;Weigel R;Chu K;Kiragga AN;Ardura-Garcia C;Anderegg N;Laurent C;Cornell M;Tweya H;Haas AD;Rice BD;Geng EH;Fox MP;Hargreaves JR;Egger M
通讯作者：
Egger M
DOI：
10.1097/qad.0000000000000243
发表时间：
2014-05-15
期刊：
AIDS (London, England)
影响因子：
--
作者：
May MT;Gompels M;Delpech V;Porter K;Orkin C;Kegg S;Hay P;Johnson M;Palfreeman A;Gilson R;Chadwick D;Martin F;Hill T;Walsh J;Post F;Fisher M;Ainsworth J;Jose S;Leen C;Nelson M;Anderson J;Sabin C;UK Collaborative HIV Cohort (UK CHIC) Study
通讯作者：
UK Collaborative HIV Cohort (UK CHIC) Study
影响因子：
11.8
作者：
Geng, Elvin H.;Odeny, Thomas A.;Martin, Jeffrey
通讯作者：
Martin, Jeffrey
影响因子：
3.7
作者：
Babo, Yohannes Demissie;Alemie, Getahun Asres;Fentaye, Fasil Walelign
通讯作者：
Fentaye, Fasil Walelign