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在安大略省,艾滋病毒耐药性测试,病毒抑制和死亡率之间的关联:一个回顾性队列研究

Lawrence Mbuagbaw^1,2,3,4,5,6, Carmen H Logie^7,8, Lehana Thabane^1,2,3,4,9,10

¹Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, Ontario, Canada.

|July 31, 2025

概括

治疗前的HIV耐药性测试没有显著影响开始抗逆转录病毒治疗 (ART) 的人群的病毒抑制或死亡率. 临床和人口因素,如年龄和基线CD4计数,与患者的结局更强烈相关.

科学领域:

传染性疾病传染性疾病
公共卫生公共卫生
艾滋病毒/艾滋病研究研究

背景情况:

抗逆转录病毒疗法 (ART) 的有效性受到药物耐药性的挑战.
在一些指导方针中建议进行抗药性测试,特别是在ART失败后,但其在未经治疗的个体中的作用需要进一步研究.
加拿大安大略省于2014年将耐药性测试作为标准护理实施,为研究其影响提供了机会.

研究的目的:

调查治疗前的HIV耐药性测试与病毒抑制之间的关联.
检查抗性检测和艾滋病毒感染者开始ART的死亡率之间的关系.
为了确定与这种人群中的病毒抑制和死亡率相关的因素.

主要方法:

使用安大略省卫生行政数据库和安大略省艾滋病毒治疗网络 (OHTN) 队列研究 (OCS) 从2005年到2018年的回顾性队列研究.
后勤回归分析比较病毒抑制 (在6-18个月内<200副本/毫升) 和在接受治疗前耐药性测试和不接受治疗前耐药性测试的个人之间的死亡.
根据年龄,性别,ART启动年份,种族,性取向,教育,收入,坚持,药物,移民身份,注射药物使用,病毒载荷和基线CD4计数进行共变量调整.

主要成果:

在1806名符合条件的参与者中,716人被分析为死亡率 (3.7%死亡),699人被分析为病毒抑制 (94.6%实现了抑制).
在对共变量进行调整后,治疗前的耐药性测试没有与病毒抑制 (OR 1.13;95% CI 0.58-2.22) 或死亡 (OR 1.06;95% CI 0.49-2.28) 有显著的关联.
病毒抑制在年龄较大,非核酸逆转录酶抑制剂 (NNRTIs) 与蛋白酶抑制剂 (PIs) 之间更有可能发生,并且基线CD4计数较高. 年龄较大与死亡几率较高有关.

结论:

治疗前的HIV耐药性测试与在开始ART的个体中改善病毒抑制或降低死亡率无关.
包括ART治疗方案,基线CD4计数和患者年龄在内的临床因素是治疗结果的重要预测因素.
这些发现表明,虽然耐药性测试很重要,但其他患者和临床特征在未经治疗的个体的ART成功中起着更重要的作用.

关键词:

艾滋病病毒艾滋病病毒艾滋病病毒安大略省安大略省安大略省安大略省安大略省政策政策政策政策电阻测试电阻测试电阻测试一个回顾性队列队列.

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