Long-term virologic responses to antiretroviral therapy among HIV-positive patients entering adherence clubs in Khayelitsha, Cape Town, South Africa: a longitudinal analysis
Long-term virologic responses to antiretroviral therapy among HIV-positive patients entering adherence clubs in Khayelitsha, Cape Town, South Africa: a longitudinal analysis
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DOI：
10.1002/jia2.25476
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发表时间：
2020-05-01
影响因子：
6
通讯作者：
Cornell, Morna
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文献类型：
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作者：
Kehoe, Kathleen;Boulle, Andrew;Cornell, Morna
在南非，2018年估计有460万人正在接受抗逆转录病毒治疗。随着普遍的检测和治疗的实施，这些数字将继续增加。鉴于数百万人需要终身护理，需要为抗逆转录病毒治疗服务提供差异化的服务模式，例如为病情稳定的患者提供坚持俱乐部（ACs）。在这项研究中，我们描述了开普敦Khayelitsha曾经进入ACs的患者的长期病毒学结果。方法我们纳入了2011年1月至2016年12月在卡耶利沙纳入ACs的成年患者，他们在入组前记录了病毒载量（VL）。使用Cox比例风险模型估计VL升高（VL >1000拷贝/mL）和确认病毒学失败（连续两次VL >1000拷贝/mL间隔一年）的危险因素。评估随时间推移的VL完整性。总体而言，8058例患者纳入分析，自AC入组以来随访16,047人年（中位随访时间为1.7年，四分位数间距[IQR]:0.9至2.9）。入组时，74%为女性，46%年龄在35 - 44岁之间，抗逆转录病毒治疗的中位持续时间为4.8年（IQR: 3.0 - 7.2）。在8058例患者中，7136例（89%）患者进行了VL检测，其中441例（6%）患者的VL升高（从进入AC后的中位时间为363天，IQR: 170至728）。年龄较大（校正风险比[aHR] 0.64, 95%可信区间[CI] 0.46至0.88）、进入AC的时间较近（aHR 0.76, 95% CI 0.68至0.84）和CD4细胞计数较高（aHR 0.67, 95% CI 0.54至0.84）对VL升高具有保护作用。在VL升高的患者中，52%（150/291）的重复VL检测随后在中位时间112天（IQR: 56至168）内确诊病毒学失败。随着时间的推移，VL检测的频率保持不变（82%至85%），超过90%的患者保持病毒学抑制。结论：本研究表明，在急性冠脉综合征患者中，vl升高的发生率较低，并证实了病毒学失败。尽管ACs迅速扩大，但大多数患者都得到了良好的监测并保持稳定，这支持了该模型的继续推广。
Introduction In South Africa, an estimated 4.6 million people were accessing antiretroviral therapy (ART) in 2018. As universal Test and Treat is implemented, these numbers will continue to increase. Given the need for lifelong care for millions of individuals, differentiated service delivery models for ART services such as adherence clubs (ACs) for stable patients are required. In this study, we describe long-term virologic outcomes of patients who have ever entered ACs in Khayelitsha, Cape Town.Methods We included adult patients enrolled in ACs in Khayelitsha between January 2011 and December 2016 with a recorded viral load (VL) before enrolment. Risk factors for an elevated VL (VL >1000 copies/mL) and confirmed virologic failure (two consecutive VLs >1000 copies/mL one year apart) were estimated using Cox proportional hazards models. VL completeness over time was assessed.Results Overall, 8058 patients were included in the analysis, contributing 16,047 person-years of follow-up from AC entry (median follow-up time 1.7 years, interquartile range [IQR]:0.9 to 2.9). At AC entry, 74% were female, 46% were aged between 35 and 44 years, and the median duration on ART was 4.8 years (IQR: 3.0 to 7.2). Among patients virologically suppressed at AC entry (n = 8058), 7136 (89%) had a subsequent VL test, of which 441 (6%) experienced an elevated VL (median time from AC entry 363 days, IQR: 170 to 728). Older age (adjusted hazard ratio [aHR] 0.64, 95% confidence interval [CI] 0.46 to 0.88), more recent year of AC entry (aHR 0.76, 95% CI 0.68 to 0.84) and higher CD4 count (aHR 0.67, 95% CI 0.54 to 0.84) were protective against experiencing an elevated VL. Among patients with an elevated VL, 52% (150/291) with a repeat VL test subsequently experienced confirmed virologic failure in a median time of 112 days (IQR: 56 to 168). Frequency of VL testing was constant over time (82 to 85%), with over 90% of patients remaining virologically suppressed.Conclusions This study demonstrates low prevalence of elevated VLs and confirmed virologic failure among patients who entered ACs. Although ACs were expanded rapidly, most patients were well monitored and remained stable, supporting the continued rollout of this model.