Characterizing long-acting injectable antiretroviral therapy eligibility and initiation at a safety net academic medical center in the southeastern United States.

IF 1.4 4区 医学 Q4 IMMUNOLOGY
Sarah E Rutstein, Christopher Lopez, Thibaut Davy-Mendez, Harsh Agarwal, Hanna Huffstetler, Angela Perhac, Barbarajean Turner, Joseph J Eron, Vivian Go, Claire E Farel, Kuo-Ping Li, Sonia Napravnik
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引用次数: 0

Abstract

Background: Long-acting injectable (LAI) cabotegravir/rilpivirine (CAB/RPV) extends dosing intervals from daily to every 8 weeks. Equitable implementation requires anticipating and addressing barriers to use. We described LAI-CAB/RPV eligibility and initiation among persons with HIV (PWH) receiving care at a Southeastern US academic medical center. Methods: We included PWH ≥18 years, in care 01/01/2020-12/31/2021, and participating in the UNC CFAR HIV Clinical Cohort. We characterized LAI-CAB/RPV eligibility, compared those with and without recent detectable viral load (VL), and described clinical outcomes on LAI-CAB/RPV. Results: Among 1672 PWH, 425 (25.4%) had LAI-CAB/RPV drug-resistance. Among 1238 LAI-eligible PWH, 8.9% had detectable VL. Median age was 53 (interquartile range 40, 61), 54.6% were non-Hispanic Black, and 73.6% male. Over one-third lived >50 miles from clinic, one-fifth were uninsured, and 7.4% reported hazardous alcohol use. Gaps in care (prior 12-month) were more common among PWH with detectable VL versus suppressed (23.1% vs 13.9%, p = 0.03). 6/47 initiated LAI-CAB/RPV had detectable VL prior to injection; >95% sustained suppression and those with detectable VL had a rapid decline in viremia. Conclusions: Three-quarters of PWH were eligible for LAI-CAB/RPV, but equitable implementation may require addressing challenges such as distance to care, inconsistent care engagement, and other comorbid conditions, particularly for PWH with viremia.

美国东南部一家安全网学术医疗中心的长效注射抗逆转录病毒疗法资格和启动特点。
背景:长效注射剂(LAI)卡博替拉韦/利匹韦林(CAB/RPV)将用药间隔从每天一次延长至每 8 周一次。公平实施需要预见并解决使用障碍。我们描述了在美国东南部一家学术医疗中心接受治疗的艾滋病病毒感染者(PWH)使用 LAI-CAB/RPV 的资格和启动情况。方法:我们纳入了 2020 年 1 月 1 日至 2021 年 12 月 31 日接受治疗并参与 UNC CFAR HIV 临床队列的年龄≥18 岁的 PWH。我们描述了接受 LAI-CAB/RPV 治疗的资格,比较了近期检测到病毒载量 (VL) 和未检测到病毒载量 (VL) 的患者,并描述了 LAI-CAB/RPV 的临床结果。结果:在1672名PWH中,425人(25.4%)对LAI-CAB/RPV产生了耐药性。在1238名符合LAI条件的PWH中,8.9%检测到VL。年龄中位数为53岁(四分位数范围为40-61岁),54.6%为非西班牙裔黑人,73.6%为男性。超过三分之一的人居住地距离诊所超过 50 英里,五分之一的人没有保险,7.4% 的人酗酒。在检测到 VL 的 PWH 与检测到 VL 被抑制的 PWH 中,护理间隔(前 12 个月)更常见(23.1% 对 13.9%,P = 0.03)。每 47 名接受 LAI-CAB/RPV 治疗的患者中有 6 人在注射前检测到 VL;超过 95% 的患者持续抑制了病毒,而检测到 VL 的患者的病毒血症迅速下降。结论:四分之三的艾滋病感染者符合接受LAI-CAB/RPV治疗的条件,但公平实施可能需要解决一些难题,如距离医疗机构的距离、医疗机构参与的不一致以及其他合并症,尤其是对有病毒血症的艾滋病感染者而言。
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来源期刊
CiteScore
2.60
自引率
7.10%
发文量
144
审稿时长
3-6 weeks
期刊介绍: The International Journal of STD & AIDS provides a clinically oriented forum for investigating and treating sexually transmissible infections, HIV and AIDS. Publishing original research and practical papers, the journal contains in-depth review articles, short papers, case reports, audit reports, CPD papers and a lively correspondence column. This journal is a member of the Committee on Publication Ethics (COPE).
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