{"title":"抗逆转录病毒治疗开始时间对艾滋病毒感染者护理保留、病毒载量抑制和死亡率的影响:泰国一所大学医院的研究","authors":"Pruke Eamsakulrat, Sasisopin Kiertiburanakul","doi":"10.1177/23259582221082607","DOIUrl":null,"url":null,"abstract":"<p><p>Studies investigating same-day antiretroviral therapy (ART) initiation demonstrate different clinical outcomes depending on settings. We retrospectively reviewed adults with newly positive human immunodeficiency virus (HIV) antibody testing. The proportion of individuals who were retained in care at 12 months was compared between early (≤2 weeks) and late (>2 weeks) ART initiation groups. Of all, the median (IQR) time from HIV diagnosis to ART initiation was 18 (9-30) days. This duration was 7 (7-13) days in the early ART initiation group (n = 116) and 28 (21-46) days in the late ART initiation group (n = 154). In the multivariate logistic regression, having pneumocystis pneumonia [odds ratio (OR) 9.30, 95% CI 2.56-33.75], tuberculosis (OR 2.21, 95% CI 1.03-4.73), and weight loss (OR 12.98, 95% CI 1.00-167.68) were associated with late ART initiation. The early ART initiation group had a slightly higher proportion of individuals retained in care at 12 months than those in the late ART initiation group (88.8% vs 80.5%, <i>P</i> = .066) and had a higher significant proportion of HIV viral load suppression (81.0% vs 70.1%, <i>P</i> = .041). No significant differences were observed in the proportion of individuals who died at 12 months (2.6% vs 3.2%, <i>P</i> = 1.000) between the two groups. Early ART initiation trends to retain individuals in care and higher HIV viral load suppression was determined. Nevertheless, ART initiation timing might not be a solely important factor in improving HIV care and minimizing mortality among HIV-infected individuals in a university hospital setting.</p>","PeriodicalId":17328,"journal":{"name":"Journal of the International Association of Providers of AIDS Care","volume":null,"pages":null},"PeriodicalIF":2.2000,"publicationDate":"2022-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8891835/pdf/","citationCount":"0","resultStr":"{\"title\":\"The Impact of Timing of Antiretroviral Therapy Initiation on Retention in Care, Viral Load Suppression and Mortality in People Living with HIV: A Study in a University Hospital in Thailand.\",\"authors\":\"Pruke Eamsakulrat, Sasisopin Kiertiburanakul\",\"doi\":\"10.1177/23259582221082607\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><p>Studies investigating same-day antiretroviral therapy (ART) initiation demonstrate different clinical outcomes depending on settings. We retrospectively reviewed adults with newly positive human immunodeficiency virus (HIV) antibody testing. The proportion of individuals who were retained in care at 12 months was compared between early (≤2 weeks) and late (>2 weeks) ART initiation groups. Of all, the median (IQR) time from HIV diagnosis to ART initiation was 18 (9-30) days. This duration was 7 (7-13) days in the early ART initiation group (n = 116) and 28 (21-46) days in the late ART initiation group (n = 154). In the multivariate logistic regression, having pneumocystis pneumonia [odds ratio (OR) 9.30, 95% CI 2.56-33.75], tuberculosis (OR 2.21, 95% CI 1.03-4.73), and weight loss (OR 12.98, 95% CI 1.00-167.68) were associated with late ART initiation. The early ART initiation group had a slightly higher proportion of individuals retained in care at 12 months than those in the late ART initiation group (88.8% vs 80.5%, <i>P</i> = .066) and had a higher significant proportion of HIV viral load suppression (81.0% vs 70.1%, <i>P</i> = .041). No significant differences were observed in the proportion of individuals who died at 12 months (2.6% vs 3.2%, <i>P</i> = 1.000) between the two groups. Early ART initiation trends to retain individuals in care and higher HIV viral load suppression was determined. 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引用次数: 0
摘要
调查当天开始抗逆转录病毒治疗(ART)的研究表明,临床结果因环境而异。我们回顾性分析了新近人类免疫缺陷病毒(HIV)抗体检测阳性的成年人。比较早期(≤2周)和晚期(≤2周)ART起始组在12个月时继续接受治疗的个体比例。总的来说,从艾滋病毒诊断到开始抗逆转录病毒治疗的中位数(IQR)时间为18(9-30)天。早期ART起始组(n = 116)的持续时间为7(7-13)天,晚期ART起始组(n = 154)的持续时间为28(21-46)天。在多因素logistic回归中,肺囊虫性肺炎[比值比(OR) 9.30, 95% CI 2.56-33.75]、结核病(OR 2.21, 95% CI 1.03-4.73)和体重减轻(OR 12.98, 95% CI 1.00-167.68)与ART开始较晚相关。早期ART开始组在12个月时保留护理的个体比例略高于晚期ART开始组(88.8%比80.5%,P = 0.066), HIV病毒载量抑制的显著比例更高(81.0%比70.1%,P = 0.041)。两组在12个月死亡的个体比例无显著差异(2.6% vs 3.2%, P = 1.000)。确定了早期抗逆转录病毒治疗的趋势,以保留患者的护理和更高的HIV病毒载量抑制。然而,在大学医院环境中,抗逆转录病毒治疗起始时间可能不是改善艾滋病毒护理和降低艾滋病毒感染者死亡率的唯一重要因素。
The Impact of Timing of Antiretroviral Therapy Initiation on Retention in Care, Viral Load Suppression and Mortality in People Living with HIV: A Study in a University Hospital in Thailand.
Studies investigating same-day antiretroviral therapy (ART) initiation demonstrate different clinical outcomes depending on settings. We retrospectively reviewed adults with newly positive human immunodeficiency virus (HIV) antibody testing. The proportion of individuals who were retained in care at 12 months was compared between early (≤2 weeks) and late (>2 weeks) ART initiation groups. Of all, the median (IQR) time from HIV diagnosis to ART initiation was 18 (9-30) days. This duration was 7 (7-13) days in the early ART initiation group (n = 116) and 28 (21-46) days in the late ART initiation group (n = 154). In the multivariate logistic regression, having pneumocystis pneumonia [odds ratio (OR) 9.30, 95% CI 2.56-33.75], tuberculosis (OR 2.21, 95% CI 1.03-4.73), and weight loss (OR 12.98, 95% CI 1.00-167.68) were associated with late ART initiation. The early ART initiation group had a slightly higher proportion of individuals retained in care at 12 months than those in the late ART initiation group (88.8% vs 80.5%, P = .066) and had a higher significant proportion of HIV viral load suppression (81.0% vs 70.1%, P = .041). No significant differences were observed in the proportion of individuals who died at 12 months (2.6% vs 3.2%, P = 1.000) between the two groups. Early ART initiation trends to retain individuals in care and higher HIV viral load suppression was determined. Nevertheless, ART initiation timing might not be a solely important factor in improving HIV care and minimizing mortality among HIV-infected individuals in a university hospital setting.