An expanded HIV care cascade: ART uptake, viral load suppression and comorbidity monitoring among adults living with HIV in Asia.

IF 1.3 4区 医学 Q4 INFECTIOUS DISEASES
Antiviral Therapy Pub Date : 2020-01-01 DOI:10.3851/IMP3379
Rimke Bijker, Nagalingeswaran Kumarasamy, Sasisopin Kiertiburanakul, Sanjay Pujari, Oon Tek Ng, Ly Pehn Sun, Tuti Parwati Merati, Kinh Van Nguyen, Man Po Lee, Do Duy Cuong, Yu Jiun Chan, Jun Yong Choi, Jeremy Ross, Matthew Law
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引用次数: 1

Abstract

Background: Comprehensive treatment and clinical management are central to improving outcomes for people living with HIV (PLHIV). We explored trends in HIV clinical care, treatment outcomes, and chronic kidney disease (CKD) and diabetes monitoring.

Methods: We included patients ≥18 years in care at ten clinical sites in eight Asian countries. Proportions of patients on antiretroviral therapy (ART), with annual viral load, and with viral load suppression (VLS; <1,000 copies/ml) were estimated by year for 2011-2016, stratified by country income level (lower-middle income [LMIC] and high-income countries [HIC]). Among those on ART in 2016 we evaluated factors associated with annual CKD and diabetes monitoring.

Results: Among 31,346 patients (67% male), the proportions of patients on ART (median ART initiation year 2011, IQR 2007-2013), with annual viral load and VLS had substantially increased by 2016 (to 94%, 42% and 92%, respectively, in LMIC and 95%, 97% and 93%, respectively, in HIC) with the larger increases over time seen in LMIC. Among those on ART in 2016, monitoring proportions in LMIC were 53% for CKD and 26% for diabetes compared with 83% and 59%, respectively, in HIC. Overall, a decreased odds of monitoring was observed for male gender, heterosexual HIV exposure, no viral load and LMIC. Diabetes monitoring was also decreased in those with viral failure.

Conclusions: Our findings highlight suboptimal monitoring of viral load, CKD and diabetes in PLHIV in Asia. There is a need for affordable and scalable monitoring options to improve the joint care for HIV and non-communicable diseases.

扩大艾滋病毒护理级联:亚洲成人艾滋病毒感染者的抗逆转录病毒药物摄取、病毒载量抑制和合并症监测
背景:综合治疗和临床管理是改善艾滋病毒感染者(PLHIV)预后的核心。我们探讨了HIV临床护理、治疗结果、慢性肾脏疾病(CKD)和糖尿病监测的趋势。方法:我们纳入了来自8个亚洲国家的10个临床站点的≥18年的患者。接受抗逆转录病毒治疗(ART)、年病毒载量和病毒载量抑制(VLS)的患者比例;结果:在31,346例患者(67%为男性)中,接受ART治疗的患者(中位ART起始年份为2011年,IQR 2007-2013年)的年病毒载量和VLS比例在2016年大幅增加(LMIC中分别为94%、42%和92%,HIC中分别为95%、97%和93%),随着时间的推移,LMIC中增加幅度更大。在2016年接受ART治疗的患者中,慢性肾病和糖尿病的LMIC监测比例分别为53%和26%,而HIC的监测比例分别为83%和59%。总体而言,男性、异性恋HIV暴露、无病毒载量和LMIC的监测几率降低。病毒衰竭患者的糖尿病监测也减少了。结论:我们的研究结果强调了亚洲PLHIV病毒载量、CKD和糖尿病监测的不理想。有必要提供负担得起和可扩展的监测方案,以改善对艾滋病毒和非传染性疾病的联合护理。
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来源期刊
Antiviral Therapy
Antiviral Therapy 医学-病毒学
CiteScore
2.60
自引率
8.30%
发文量
35
审稿时长
4-8 weeks
期刊介绍: Antiviral Therapy (an official publication of the International Society of Antiviral Research) is an international, peer-reviewed journal devoted to publishing articles on the clinical development and use of antiviral agents and vaccines, and the treatment of all viral diseases. Antiviral Therapy is one of the leading journals in virology and infectious diseases. The journal is comprehensive, and publishes articles concerning all clinical aspects of antiviral therapy. It features editorials, original research papers, specially commissioned review articles, letters and book reviews. The journal is aimed at physicians and specialists interested in clinical and basic research.
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