根据普遍艾滋病毒治疗指南,长期艾滋病毒护理结果:在25个国家进行了一项回顾性队列研究
Ellen Brazier1,2, Olga Tymejczyk1, Kara Wools-Kaloustian3
1City University of New York, Institute for Implementation Science in Population Health (ISPH), New York, New York, United States of America.
PLoS medicine
|March 18, 2024
概括
新的普遍艾滋病毒治疗指南与抗逆转录病毒治疗 (ART) 开始后的36个月内患者失去护理的增加有关. 病毒载量监测和抑制率在保留患者中基本保持不变,突出显示了长期艾滋病毒管理中的关键差距.
科学领域:
- 公共卫生 公共卫生
- 流行病学 流行病学
- 传染病研究 传染病研究
背景情况:
- 全球普遍采用艾滋病毒治疗指南改善了及时的抗逆转录病毒疗法 (ART) 吸收.
- 长期的结果,包括患者消耗和病毒载荷监测,在现实环境中仍未得到充分研究.
- 在ART开始后的24个月和36个月,关于患者保留和病毒抑制的数据有限.
研究的目的:
- 评估普遍采用艾滋病毒治疗指南对长期患者保留的影响.
- 评估指南通过后病毒载量 (VL) 监测和病毒抑制 (VS) 的变化.
- 在全球不同地区,在启动ART后的24个月和36个月分析患者退化情况.
主要方法:
- 在IeDEA联盟 (2012-2018) 的25个国家中,对66,963名15岁以上的ART-naïve患者进行了回顾性队列分析.
- 通过竞争风险回归和Cox比例危险模型,比较在国家指导方针通过之前和之后注册的患者的结果.
- 在ART开始后的12,24和36个月内估计临床损失 (LTC),保留,VL监测和VS率.
主要成果:
- 在准则通过后的入学与12个月,24个月和36个月的临床损失风险显著增加有关 (aHRs从1.25到1.38不等).
- 在保留的患者中,病毒载量监测显示在ART启动后12个月内仅有边际改善.
- 病毒抑制率很高 (86.0%90.3%),并且在准则采用前和后的组之间没有显著差异.
结论:
- 采用普遍的艾滋病毒治疗指南与ART启动后的36个月内患者保留率下降相关.
- 在继续接受治疗的患者中,观察到病毒载荷监测和病毒抑制的最小变化.
- 持续监测长期艾滋病毒护理结果对于解决退化和改善护理质量至关重要.
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