The changing use and program costs of HIV-related laboratory testing over 20 years in an HIV cohort.

IF 4.5 3区医学 Q2 IMMUNOLOGY

Current Opinion in HIV and AIDS Pub Date : 2023-09-01 DOI:10.1097/COH.0000000000000814

Jessica Dalere, Raynell Lang, Hartmut B Krentz, Brenda Beckthold, M John Gill

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引用次数: 0

Abstract

Purpose of review: The improved health of persons with HIV (PWH) resulting from antiretroviral therapy (ART) has led to recommendations for reduced laboratory monitoring. We studied, for all PWH in care over 20 years at the Southern Alberta Clinic (SAC), Canada, the changing use and results of HIV-specific laboratory testing [i.e., CD4+ testing, plasma HIV viral load (PVL), and genotypic antiretroviral resistance testing (GART)].In this descriptive retrospective longitudinal cohort observational study, we examined HIV-specific laboratory testing for all PWH from 2000 to 2020 within the context of HIV-related health outcomes, program costs, and mortality.

Recent findings: The number of PWH in care increased from 755 in 2000 to 2050 in 2020. Annual CD4+ testing per PWH increased from 2.7 per person in 2000 peaking to 3.5 in 2005 but decreasing to 1.4 by 2020. Annual PVL tests per PWH gradually decreased from 3.2 in 2000 to 2.0 in 2020. GART increased from 93 tests in 2000 to 315 in 2008 decreasing to 127 in 2020. Patients received GART at baseline, and after a viral breakthrough when indicated. Viral suppression rates for the population increased from 66 to 96%; median CD4+ cell count increased from 443 to 470 cells/μl, and overall morbidity decreased from 9.2 to 2.0% by 2020, respectively. Annual per patient laboratory costs decreased from a high of $302 in 2008 to $161 by 2020.

Summary: The reduced annual laboratory surveillance per PWH associated with modern ART resulted in modest cost savings and no apparent loss in quality of HIV care.

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20年来艾滋病毒队列中艾滋病毒相关实验室检测的使用变化和项目成本

审查目的:抗逆转录病毒治疗(ART)改善了艾滋病毒感染者(PWH)的健康状况，因此建议减少实验室监测。我们研究了在加拿大南阿尔伯塔诊所(SAC)治疗20多年的所有PWH患者中，HIV特异性实验室检测(即CD4+检测、血浆HIV病毒载量(PVL)和基因型抗逆转录病毒耐药性检测(GART))的使用变化和结果。在这项描述性回顾性纵向队列观察研究中，我们在与hiv相关的健康结果、项目成本和死亡率的背景下，检查了2000年至2020年所有PWH的hiv特异性实验室检测。最新发现:护理中的PWH人数从2000年的755人增加到2020年的2050人。每个PWH每年的CD4+检测从2000年的每人2.7次增加到2005年的3.5次，但到2020年下降到1.4次。每艘PWH每年的PVL测试从2000年的3.2次逐渐下降到2020年的2.0次。GART测试从2000年的93次增加到2008年的315次，减少到2020年的127次。患者在基线时接受GART治疗，并在病毒突破后接受治疗。种群的病毒抑制率从66%提高到96%;到2020年，中位CD4+细胞计数从443个增加到470个/μl，总发病率从9.2%下降到2.0%。每位患者每年的实验室费用从2008年的302美元降至2020年的161美元。摘要:与现代抗逆转录病毒治疗相关的每个PWH的年度实验室监测减少导致了适度的成本节约，并且没有明显的艾滋病毒护理质量损失。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Current Opinion in HIV and AIDS IMMUNOLOGY-INFECTIOUS DISEASES

CiteScore

7.40

自引率

7.30%

发文量

115

审稿时长

6-12 weeks

期刊介绍： Published bimonthly and offering a unique and wide ranging perspective on the key developments in the field, each issue of Current Opinion in HIV and AIDS features hand-picked review articles from our team of expert editors. With six disciplines published across the year – including HIV and ageing, a HIV vaccine, and epidemiology – every issue also contains annotated reference detailing the merits of the most important papers.