Abstract：
Unsuppressed HIV viremia damages immunity and increases the risk for secondary HIV transmission. Successful engagement of persons with HIV (PWH) into care resulting in viral suppression is vital. PWH already engaged in care, who, after achieving viral suppression, experience viral breakthrough episodes (VBEs) with a sequence of suppressed/unsuppressed/suppressed viral loads remain problematic. We examined the frequency and outcomes of PWH experiencing VBE. HIV care is provided at no cost to all patients under Alberta\'s universal health program. All PWH followed at Southern Alberta Clinic, Canada, with two or more viral load tests between January 1, 2010, and January 1, 2020, were evaluated. Sociodemographic, clinical, and lifestyle variables were determined along with health outcomes (CD4 levels, HIV-related hospitalizations, and HIV/AIDS-related mortality). Descriptive and multi-variable analyses were performed comparing PWH with and without VBEs. Of 2096 PWH, 386 (18%) experienced one or more VBEs. A higher risk of VBEs was seen in adjusted analyses in those diagnosed age ≤40 years. Increased risk of VBE was seen with injection drug use (46%) and in heterosexuals (56%) compared with MSM. Experience of intimate partner violence, unstable housing, homelessness, and past incarceration also increased risks by 36%, 44% 79%, and 51%, respectively. PWH with VBEs experienced lower CD4 counts (median -417/mm3 vs. 576/mm3), higher rates of HIV-related hospitalizations (16% vs. 5%), and a 67% increased risk of death (95% confidence interval 1.17-2.39) over the study period. Nearly 20% of all PWH, after achieving viral suppression, experienced VBEs. Distinct clinical, lifestyle, and life experiences predict PWH at greatest risk for more than one VBEs. Serious negative health outcomes of VBEs were identified, suggesting that novel customized care programming is required for PWH at greatest risk.
摘要：
未抑制的HIV病毒血症会损害免疫力并增加继发性HIV传播的风险。HIV（PWH）患者成功参与治疗，从而抑制病毒是至关重要的。PWH已经从事护理，谁,在实现病毒抑制后，经历一系列抑制/未抑制/抑制的病毒载量的病毒突破发作（VBE）仍然存在问题。我们检查了PWH经历VBE的频率和结果。艾伯塔省的全民健康计划为所有患者免费提供艾滋病毒护理。所有PWH都在阿尔伯塔省南部诊所跟进，加拿大,对2010年1月1日至2020年1月1日期间的两次或两次以上病毒载量测试进行了评估.社会人口统计学，临床,和生活方式变量与健康结果一起确定(CD4水平，与艾滋病毒相关的住院治疗，和艾滋病毒/艾滋病相关死亡率)。进行描述性和多变量分析，比较有和没有VBE的PWH。在2096PWH中，386（18%）经历了一个或多个VBE。在那些诊断年龄≤40岁的患者中，在校正分析中发现VBE的风险更高。与MSM相比，使用注射药物（46％）和异性恋者（56％）的VBE风险增加。亲密伴侣暴力的经验，不稳定的住房，无家可归,过去的监禁也增加了36%的风险，44%79%,51%,分别。使用VBE的PWH的CD4计数较低（中位数-417/mm3与576/mm3),与艾滋病毒相关的住院率更高(16%vs.5%),研究期间死亡风险增加67%(95%置信区间1.17-2.39).所有PWH的近20%，在实现病毒抑制后，经验丰富的VBE。独特的临床，生活方式,和生活经验预测PWH在一个以上的VBE中风险最大。确定了VBE的严重负面健康结果，这表明风险最大的PWH需要新颖的定制护理程序。
