{"title":"南沃罗区公立医院接受二线抗逆转录病毒治疗的成人病毒再抑制时间及其预测因素:分层Cox模型","authors":"Dagnachew Melak, Shambel Wedajo, Reta Dewau","doi":"10.2147/HIV.S406372","DOIUrl":null,"url":null,"abstract":"<p><strong>Background: </strong>Even though there are many patients on second-line antiretroviral therapy (ART) in Ethiopia, there is a paucity of evidence on the rate of viral resuppression and its predictors. Therefore, this study aimed to determine a time to viral resuppression and identify predictors among adults on second-line ART in South Wollo public hospitals, northeast Ethiopia.</p><p><strong>Methods: </strong>A retrospective-cohort study design was employed using patients enrolled in second-line ART from August 28, 2016 to April 10, 2021. Data were collected using a structured data-extraction checklist with a sample size of 364 second-line ART patients from February 16 to March 30, 2021. EpiData 4.6 was used for data entry and Stata 14.2 was used for analysis. The Kaplan-Meier method was used for estimating time to viral resuppression. The Shönfield test was used to check the proportional-hazard assumption, and the \"no interaction\" stratified Cox assumption was checked using the likelihood-ratio test. A stratified Cox model was applied to identify predictors of viral resuppression.</p><p><strong>Results: </strong>Median time to viral re-suppression in patients on a second-line regimen was 10 (IQR 7-12) months. BeingFemale (AHR 1.31, 95% CI 1.01-1.69), low viral load count at switch (AHR 1.98, 95% CI 1.26-3.11), normal-range BMI at switch (AHR 1.42, 95% CI 1.03-1.95), and lopinavir-based second-line regimen (AHR 1.72, 95% CI 1.15-2.57) were significant predictors of early time to viral resuppression after stratification by WHO stage and adherence level.</p><p><strong>Conclusion: </strong>Median time to viral re-suppression after switching to second-line ART was 10 months. In the stratified Cox model, female sex, baseline viral copies, second-line regimen type, and BMI at switch were statistically significant predictors of time to viral resuppression. Different stakeholders working on the HIV program should maintain viral resuppression by addressing significant predictors, and ART clinicians should consider ritonavir-boosted lopinavir based second-line ART for newly switched patients.</p>","PeriodicalId":46555,"journal":{"name":"HIV AIDS-Research and Palliative Care","volume":null,"pages":null},"PeriodicalIF":1.5000,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/51/7b/hiv-15-411.PMC10329832.pdf","citationCount":"0","resultStr":"{\"title\":\"Time to Viral Re-suppression and Its Predictors among Adults on Second-Line Antiretroviral Therapy in South Wollo Zone Public Hospitals: Stratified Cox Model.\",\"authors\":\"Dagnachew Melak, Shambel Wedajo, Reta Dewau\",\"doi\":\"10.2147/HIV.S406372\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><strong>Background: </strong>Even though there are many patients on second-line antiretroviral therapy (ART) in Ethiopia, there is a paucity of evidence on the rate of viral resuppression and its predictors. Therefore, this study aimed to determine a time to viral resuppression and identify predictors among adults on second-line ART in South Wollo public hospitals, northeast Ethiopia.</p><p><strong>Methods: </strong>A retrospective-cohort study design was employed using patients enrolled in second-line ART from August 28, 2016 to April 10, 2021. Data were collected using a structured data-extraction checklist with a sample size of 364 second-line ART patients from February 16 to March 30, 2021. EpiData 4.6 was used for data entry and Stata 14.2 was used for analysis. The Kaplan-Meier method was used for estimating time to viral resuppression. The Shönfield test was used to check the proportional-hazard assumption, and the \\\"no interaction\\\" stratified Cox assumption was checked using the likelihood-ratio test. A stratified Cox model was applied to identify predictors of viral resuppression.</p><p><strong>Results: </strong>Median time to viral re-suppression in patients on a second-line regimen was 10 (IQR 7-12) months. BeingFemale (AHR 1.31, 95% CI 1.01-1.69), low viral load count at switch (AHR 1.98, 95% CI 1.26-3.11), normal-range BMI at switch (AHR 1.42, 95% CI 1.03-1.95), and lopinavir-based second-line regimen (AHR 1.72, 95% CI 1.15-2.57) were significant predictors of early time to viral resuppression after stratification by WHO stage and adherence level.</p><p><strong>Conclusion: </strong>Median time to viral re-suppression after switching to second-line ART was 10 months. In the stratified Cox model, female sex, baseline viral copies, second-line regimen type, and BMI at switch were statistically significant predictors of time to viral resuppression. Different stakeholders working on the HIV program should maintain viral resuppression by addressing significant predictors, and ART clinicians should consider ritonavir-boosted lopinavir based second-line ART for newly switched patients.</p>\",\"PeriodicalId\":46555,\"journal\":{\"name\":\"HIV AIDS-Research and Palliative Care\",\"volume\":null,\"pages\":null},\"PeriodicalIF\":1.5000,\"publicationDate\":\"2023-01-01\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/51/7b/hiv-15-411.PMC10329832.pdf\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"HIV AIDS-Research and Palliative Care\",\"FirstCategoryId\":\"1085\",\"ListUrlMain\":\"https://doi.org/10.2147/HIV.S406372\",\"RegionNum\":0,\"RegionCategory\":null,\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"\",\"PubModel\":\"\",\"JCR\":\"Q4\",\"JCRName\":\"INFECTIOUS DISEASES\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"HIV AIDS-Research and Palliative Care","FirstCategoryId":"1085","ListUrlMain":"https://doi.org/10.2147/HIV.S406372","RegionNum":0,"RegionCategory":null,"ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q4","JCRName":"INFECTIOUS DISEASES","Score":null,"Total":0}
引用次数: 0
摘要
背景:尽管埃塞俄比亚有许多患者接受二线抗逆转录病毒治疗(ART)，但缺乏关于病毒再抑制率及其预测因素的证据。因此，本研究旨在确定在埃塞俄比亚东北部南沃罗公立医院接受二线抗逆转录病毒治疗的成年人中病毒再抑制的时间并确定预测因素。方法:采用回顾性队列研究设计，纳入2016年8月28日至2021年4月10日接受二线ART治疗的患者。使用结构化数据提取检查表收集数据，样本量为364例二线ART患者，时间为2021年2月16日至3月30日。数据录入使用EpiData 4.6，分析使用Stata 14.2。Kaplan-Meier方法用于估计病毒再抑制的时间。比例风险假设采用Shönfield检验，“无相互作用”分层Cox假设采用似然比检验。采用分层Cox模型确定病毒再抑制的预测因子。结果:二线方案患者病毒再抑制的中位时间为10个月(IQR 7-12)。女性(AHR 1.31, 95% CI 1.01-1.69)、切换时的低病毒载量计数(AHR 1.98, 95% CI 1.26-3.11)、切换时的正常范围BMI (AHR 1.42, 95% CI 1.03-1.95)和基于洛哌那韦的二线方案(AHR 1.72, 95% CI 1.15-2.57)是按WHO分期和依从水平分层后早期进行病毒再抑制的重要预测因子。结论:改用二线抗逆转录病毒治疗后病毒再抑制的中位时间为10个月。在分层Cox模型中，女性性别、基线病毒拷贝数、二线治疗方案类型和切换时的BMI是病毒再抑制时间的统计学显著预测因子。致力于HIV项目的不同利益相关者应该通过解决重要的预测因素来维持病毒再抑制，抗逆转录病毒治疗临床医生应该考虑为新转换的患者使用利托那韦增强的洛匹那韦二线抗逆转录病毒治疗。
Time to Viral Re-suppression and Its Predictors among Adults on Second-Line Antiretroviral Therapy in South Wollo Zone Public Hospitals: Stratified Cox Model.
Background: Even though there are many patients on second-line antiretroviral therapy (ART) in Ethiopia, there is a paucity of evidence on the rate of viral resuppression and its predictors. Therefore, this study aimed to determine a time to viral resuppression and identify predictors among adults on second-line ART in South Wollo public hospitals, northeast Ethiopia.
Methods: A retrospective-cohort study design was employed using patients enrolled in second-line ART from August 28, 2016 to April 10, 2021. Data were collected using a structured data-extraction checklist with a sample size of 364 second-line ART patients from February 16 to March 30, 2021. EpiData 4.6 was used for data entry and Stata 14.2 was used for analysis. The Kaplan-Meier method was used for estimating time to viral resuppression. The Shönfield test was used to check the proportional-hazard assumption, and the "no interaction" stratified Cox assumption was checked using the likelihood-ratio test. A stratified Cox model was applied to identify predictors of viral resuppression.
Results: Median time to viral re-suppression in patients on a second-line regimen was 10 (IQR 7-12) months. BeingFemale (AHR 1.31, 95% CI 1.01-1.69), low viral load count at switch (AHR 1.98, 95% CI 1.26-3.11), normal-range BMI at switch (AHR 1.42, 95% CI 1.03-1.95), and lopinavir-based second-line regimen (AHR 1.72, 95% CI 1.15-2.57) were significant predictors of early time to viral resuppression after stratification by WHO stage and adherence level.
Conclusion: Median time to viral re-suppression after switching to second-line ART was 10 months. In the stratified Cox model, female sex, baseline viral copies, second-line regimen type, and BMI at switch were statistically significant predictors of time to viral resuppression. Different stakeholders working on the HIV program should maintain viral resuppression by addressing significant predictors, and ART clinicians should consider ritonavir-boosted lopinavir based second-line ART for newly switched patients.
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