PDF(Pubmed)
Abstract：
Viral load assessment for people living with HIV is key for monitoring treatment and achieving the 95-95-95. In this study, we aimed to assess the degree of viral suppression at different thresholds and treatment duration after the introduction of dolutegravir-based therapy in ten public hospitals in Sierra Leone.
We used a cross-sectional study design to recruits patients aged 18 years or older between August 2022 and January 2023. Statistical analyses were performed using R-software. Logistic regression was used to assess factors independently associated with viral suppression. The level of significance was set at P < 0.05.
Of the 2,253 patients recruited, 1,720 (76%) were women and 1,705 (76%) were receiving a fixed dose combination of tenofovir, lamivudine and dolutegravir. The median age and duration of anti-retroviral therapy (ART) was 36.0 (IQR, 28.0-45.0) years and 40.9 (IQR, 14.4-79.6) months, respectively. Using a threshold of HIV RNA < 1000 copies/mL, 1,715 (88.4%) patients on ART for more than 6 months were virally suppressed. Viral suppression rates were higher with dolutegravir-based (1,277, 89.5%) than efavirenz-based (418, 86.2%) ART. HIV RNA was < 200 copies/mL in 1,643 (84.6%) patients or < 50 copies/mL in 1,487 (76.6%) patients or between 50 and 999 copies/mL in 228 (11.7%) patients. Viral suppression rates at different ART durations (months) were as follows: 84.2% (≤ 3), 88.8% (4-6), 90.9% (6-12), and 88.1% (> 12). Viral suppression rates were higher for patients aged 40 or older (40-50 years: aOR 2.05, 95%CI 1.41-3.04, P < 0.01; 50-60 years: aOR 2.51, 95%CI 1.53-4.35, P < 0.01; >60 years: aOR 2.69, 95%CI 1.28-6.63, P = 0.02). Men had 49% lower odds of viral suppression than women (aOR 0.50, 95% CI 0.38-0.67, P < 0.01).
We report a viral suppression rate of 88.4% among patients on treatment for at least 6 months, with higher rate of suppression with dolutegravir than efavirenz. Factors associated with virological suppression were age and gender, emphasizing the need for innovative differentiated ART delivery models to optimize viral suppression and achieve the 95% target.
We used a cross-sectional study design to recruits patients aged 18 years or older between August 2022 and January 2023. Statistical analyses were performed using R-software. Logistic regression was used to assess factors independently associated with viral suppression. The level of significance was set at P < 0.05.
Of the 2,253 patients recruited, 1,720 (76%) were women and 1,705 (76%) were receiving a fixed dose combination of tenofovir, lamivudine and dolutegravir. The median age and duration of anti-retroviral therapy (ART) was 36.0 (IQR, 28.0-45.0) years and 40.9 (IQR, 14.4-79.6) months, respectively. Using a threshold of HIV RNA < 1000 copies/mL, 1,715 (88.4%) patients on ART for more than 6 months were virally suppressed. Viral suppression rates were higher with dolutegravir-based (1,277, 89.5%) than efavirenz-based (418, 86.2%) ART. HIV RNA was < 200 copies/mL in 1,643 (84.6%) patients or < 50 copies/mL in 1,487 (76.6%) patients or between 50 and 999 copies/mL in 228 (11.7%) patients. Viral suppression rates at different ART durations (months) were as follows: 84.2% (≤ 3), 88.8% (4-6), 90.9% (6-12), and 88.1% (> 12). Viral suppression rates were higher for patients aged 40 or older (40-50 years: aOR 2.05, 95%CI 1.41-3.04, P < 0.01; 50-60 years: aOR 2.51, 95%CI 1.53-4.35, P < 0.01; >60 years: aOR 2.69, 95%CI 1.28-6.63, P = 0.02). Men had 49% lower odds of viral suppression than women (aOR 0.50, 95% CI 0.38-0.67, P < 0.01).
We report a viral suppression rate of 88.4% among patients on treatment for at least 6 months, with higher rate of suppression with dolutegravir than efavirenz. Factors associated with virological suppression were age and gender, emphasizing the need for innovative differentiated ART delivery models to optimize viral suppression and achieve the 95% target.
摘要：
背景：HIV感染者的病毒载量评估是监测治疗和实现95-95-95的关键。在这项研究中,我们旨在评估塞拉利昂10家公立医院采用基于dolutegravir的治疗后不同阈值和治疗持续时间下的病毒抑制程度.
方法：我们采用横断面研究设计，在2022年8月至2023年1月期间招募18岁或以上的患者。使用R软件进行统计分析。Logistic回归用于评估与病毒抑制独立相关的因素。显著性水平设定为P<0.05。
结果：在招募的2,253名患者中，1,720（76％）是女性和1,705（76％）正在接受替诺福韦的固定剂量组合，拉米夫定和杜鲁特韦.抗逆转录病毒治疗（ART）的中位年龄和持续时间为36.0（IQR，28.0-45.0)年和40.9(IQR，14.4-79.6)月，分别。使用HIVRNA的阈值<1000拷贝/mL，接受ART治疗超过6个月的1,715例（88.4％）患者受到病毒抑制。以dolutegravir为基础的ART的病毒抑制率（1,277，89.5％）高于以efavirenz为基础的ART（418，86.2％）。1,643（84.6％）患者的HIVRNA<200拷贝/mL，或1,487（76.6％）患者的HIVRNA<50拷贝/mL，或在228（11.7％）患者的50至999拷贝/mL之间。不同ART持续时间（月）的病毒抑制率如下：84.2%（≤3），88.8%（4-6），90.9%（6-12），88.1%(>12)。40岁或以上患者的病毒抑制率较高（40-50岁：aOR2.05，95CI1.41-3.04，P<0.01；50-60岁：aOR2.51，95CI1.53-4.35，P<0.01；>60岁：aOR2.69，95CI1.28-6.63，P=0.02）。男性的病毒抑制几率比女性低49％（aOR0.50，95％CI0.38-0.67，P<0.01）。
结论：我们报告在治疗至少6个月的患者中，病毒抑制率为88.4%，杜鲁特韦的抑制率高于依非韦伦。与病毒学抑制相关的因素是年龄和性别，强调需要创新的差异化ART递送模式来优化病毒抑制并实现95%的目标。
方法：我们采用横断面研究设计，在2022年8月至2023年1月期间招募18岁或以上的患者。使用R软件进行统计分析。Logistic回归用于评估与病毒抑制独立相关的因素。显著性水平设定为P<0.05。
结果：在招募的2,253名患者中，1,720（76％）是女性和1,705（76％）正在接受替诺福韦的固定剂量组合，拉米夫定和杜鲁特韦.抗逆转录病毒治疗（ART）的中位年龄和持续时间为36.0（IQR，28.0-45.0)年和40.9(IQR，14.4-79.6)月，分别。使用HIVRNA的阈值<1000拷贝/mL，接受ART治疗超过6个月的1,715例（88.4％）患者受到病毒抑制。以dolutegravir为基础的ART的病毒抑制率（1,277，89.5％）高于以efavirenz为基础的ART（418，86.2％）。1,643（84.6％）患者的HIVRNA<200拷贝/mL，或1,487（76.6％）患者的HIVRNA<50拷贝/mL，或在228（11.7％）患者的50至999拷贝/mL之间。不同ART持续时间（月）的病毒抑制率如下：84.2%（≤3），88.8%（4-6），90.9%（6-12），88.1%(>12)。40岁或以上患者的病毒抑制率较高（40-50岁：aOR2.05，95CI1.41-3.04，P<0.01；50-60岁：aOR2.51，95CI1.53-4.35，P<0.01；>60岁：aOR2.69，95CI1.28-6.63，P=0.02）。男性的病毒抑制几率比女性低49％（aOR0.50，95％CI0.38-0.67，P<0.01）。
结论：我们报告在治疗至少6个月的患者中，病毒抑制率为88.4%，杜鲁特韦的抑制率高于依非韦伦。与病毒学抑制相关的因素是年龄和性别，强调需要创新的差异化ART递送模式来优化病毒抑制并实现95%的目标。
