Abstract：
BACKGROUND: We analyzed the STREAM (Simplifying HIV TREAtment and Monitoring) study to determine risk factors associated with HIV viraemia and poor retention 18 months after initiation of antiretroviral therapy (ART).
METHODS: The STREAM study was an open-label randomized controlled trial in Durban, South Africa, that enrolled 390 people living with HIV presenting for their first HIV viral load measurement ~6 months after ART initiation. We used modified Poisson regression with robust standard errors to describe associations between baseline characteristics and three HIV outcomes 18 months after ART initiation: HIV viraemia (>50 copies/mL), poor retention in HIV care, and a composite outcome of poor retention in care and/or HIV viraemia.
RESULTS: Approximately 18 months after ART initiation, 45 (11.5%) participants were no longer retained in care and 43 (11.8%) had viraemia. People with CD4 counts <200 and those with viraemia 6 months after ART initiation were significantly more likely to have viraemia 18 months after ART initiation (adjusted relative risk [aRR] 4.0; 95% confidence interval [CI] 2.1-7.5 and aRR 5.5; 95% CI 3.3-9.0, respectively). People who did not disclose their HIV status and had viraemia after ART initiation were more likely to not be retained in care 12 months later (aRR 2.6; 95% CI 1.1-6.1 and aRR 2.2; 95% CI 1.0-4.8). People with a CD4 count <200 and those with viraemia were more likely to not achieve the composite outcome 18 months after ART initiation.
CONCLUSIONS: Viraemia after ART initiation was the strongest predictor of subsequent viraemia and poor care retention. Understanding early indicators can help target our interventions to better engage people who may be more likely to experience persistent viraemia or disengage from HIV care.
METHODS: The STREAM study was an open-label randomized controlled trial in Durban, South Africa, that enrolled 390 people living with HIV presenting for their first HIV viral load measurement ~6 months after ART initiation. We used modified Poisson regression with robust standard errors to describe associations between baseline characteristics and three HIV outcomes 18 months after ART initiation: HIV viraemia (>50 copies/mL), poor retention in HIV care, and a composite outcome of poor retention in care and/or HIV viraemia.
RESULTS: Approximately 18 months after ART initiation, 45 (11.5%) participants were no longer retained in care and 43 (11.8%) had viraemia. People with CD4 counts <200 and those with viraemia 6 months after ART initiation were significantly more likely to have viraemia 18 months after ART initiation (adjusted relative risk [aRR] 4.0; 95% confidence interval [CI] 2.1-7.5 and aRR 5.5; 95% CI 3.3-9.0, respectively). People who did not disclose their HIV status and had viraemia after ART initiation were more likely to not be retained in care 12 months later (aRR 2.6; 95% CI 1.1-6.1 and aRR 2.2; 95% CI 1.0-4.8). People with a CD4 count <200 and those with viraemia were more likely to not achieve the composite outcome 18 months after ART initiation.
CONCLUSIONS: Viraemia after ART initiation was the strongest predictor of subsequent viraemia and poor care retention. Understanding early indicators can help target our interventions to better engage people who may be more likely to experience persistent viraemia or disengage from HIV care.
摘要：
背景：我们分析了STREAM（简化HIV治疗和监测）研究，以确定在开始抗逆转录病毒治疗（ART）后18个月与HIV病毒血症和保留不良相关的危险因素。
方法：STREAM研究是一项在德班的开放标签随机对照试验，南非,该研究招募了390名HIV感染者，他们在ART开始后约6个月进行首次HIV病毒载量测量。我们使用具有稳健标准误差的改良泊松回归来描述基线特征与ART开始后18个月的三种HIV结局之间的关联：HIV病毒血症（>50拷贝/mL），在艾滋病毒护理中的保留率差，以及护理保留不良和/或HIV病毒血症的复合结局。
结果：开始ART后大约18个月，45名（11.5％）参与者不再接受护理，43名（11.8％）患有病毒血症。ART开始后6个月CD4计数<200的人和病毒血症的人在ART开始后18个月明显更有可能发生病毒血症(分别为校正相对危险度[aRR]4.0;95%置信区间[CI]2.1-7.5和aRR5.5;95%CI3.3-9.0)。在开始ART后未透露其HIV感染状况和病毒血症的患者在12个月后更有可能未被保留在治疗中(aRR2.6;95%CI1.1-6.1和aRR2.2;95%CI1.0-4.8)。CD4计数<200的人和病毒血症患者在ART开始18个月后更有可能无法达到复合结局。
结论：ART开始后的病毒血症是后续病毒血症和护理保留不良的最强预测因子。了解早期指标可以帮助我们的干预措施，以更好地吸引更有可能经历持续性病毒血症或脱离艾滋病毒护理的人。
方法：STREAM研究是一项在德班的开放标签随机对照试验，南非,该研究招募了390名HIV感染者，他们在ART开始后约6个月进行首次HIV病毒载量测量。我们使用具有稳健标准误差的改良泊松回归来描述基线特征与ART开始后18个月的三种HIV结局之间的关联：HIV病毒血症（>50拷贝/mL），在艾滋病毒护理中的保留率差，以及护理保留不良和/或HIV病毒血症的复合结局。
结果：开始ART后大约18个月，45名（11.5％）参与者不再接受护理，43名（11.8％）患有病毒血症。ART开始后6个月CD4计数<200的人和病毒血症的人在ART开始后18个月明显更有可能发生病毒血症(分别为校正相对危险度[aRR]4.0;95%置信区间[CI]2.1-7.5和aRR5.5;95%CI3.3-9.0)。在开始ART后未透露其HIV感染状况和病毒血症的患者在12个月后更有可能未被保留在治疗中(aRR2.6;95%CI1.1-6.1和aRR2.2;95%CI1.0-4.8)。CD4计数<200的人和病毒血症患者在ART开始18个月后更有可能无法达到复合结局。
结论：ART开始后的病毒血症是后续病毒血症和护理保留不良的最强预测因子。了解早期指标可以帮助我们的干预措施，以更好地吸引更有可能经历持续性病毒血症或脱离艾滋病毒护理的人。
