Impact of Age on Retention in Care and Viral Suppression

被引：84

作者：

Yehia, Baligh R. ^{[1
]}

Rebeiro, Peter ^{[2
]}

Althoff, Keri N. ^{[3
]}

Agwu, Allison L. ^{[3
]}

Horberg, Michael A. ^{[4
]}

Samji, Hasina ^{[5
]}

Napravnik, Sonia ^{[6
]}

Mayer, Kenneth ^{[7
]}

Tedaldi, Ellen ^{[8
]}

Silverberg, Michael J. ^{[9
]}

Thorne, Jennifer E. ^{[2
]}

Burchell, Ann N. ^{[10
]}

Rourke, Sean B. ^{[10
]}

Rachlis, Anita ^{[10
]}

Mayor, Angel ^{[11
]}

Gill, Michael J. ^{[12
]}

Zinski, Anne ^{[13
]}

Ohl, Michael ^{[14
]}

Anastos, Kathryn ^{[15
]}

Abraham, Alison G. ^{[3
]}

Kitahata, Mari M. ^{[16
]}

Moore, Richard D. ^{[3
]}

Gebo, Kelly A. ^{[3
]}

机构：

[1] Univ Penn, Dept Med, Perelman Sch Med, Philadelphia, PA 19104 USA

[2] Vanderbilt Univ, Sch Med, Dept Med, Nashville, TN 37212 USA

[3] Johns Hopkins Univ, Dept Epidemiol, Baltimore, MD USA

[4] Kaiser Permanente Midatlantic States, Midatlantic Permanente Res Inst, Rockville, MD USA

[5] British Columbia Ctr Excellence HIV AIDS, Vancouver, BC, Canada

[6] Univ N Carolina, Dept Med, Div Infect Dis, Chapel Hill, NC USA

[7] Fenway Inst, Boston, MA USA

[8] Temple Univ, Dept Med, Philadelphia, PA 19122 USA

[9] Kaiser Permanente No Calif, Div Res, Oakland, CA USA

[10] Ontario HIV Treatment Network, Toronto, ON, Canada

[11] Univ Cent Caribe, Ctr Retrovirus Res, Bayamon, PR USA

[12] Univ Calgary, Dept Med, Calgary, AB, Canada

[13] Univ Alabama Birmingham, Div Infect Dis, Birmingham, AL USA

[14] Iowa City Vet Affairs Med Ctr, Ctr Comprehens Access & Delivery Res & Evaluat, Iowa City, IA USA

[15] Montefiore Med Ctr, Bronx, NY 10467 USA

[16] Univ Washington, Dept Med, Div Allergy & Infect Dis, Seattle, WA USA

来源：

JAIDS-JOURNAL OF ACQUIRED IMMUNE DEFICIENCY SYNDROMES | 2015年 / 68卷 / 04期

基金：

美国国家卫生研究院; 加拿大健康研究院; 美国医疗保健研究与质量局;

关键词：

retention in care; viral suppression; age; engagement; HIV; HIV-RELATED STIGMA; ACTIVE ANTIRETROVIRAL THERAPY; MEDICATION ADHERENCE; INFECTED PERSONS; ADULTS; OLDER; RISK; PREDICTORS; BEHAVIORS; HIV/AIDS;

D O I：

10.1097/QAI.0000000000000489

中图分类号：

R392 [医学免疫学]; Q939.91 [免疫学];

学科分类号：

100102 ;

摘要：

Background: Retention in care is important for all HIV-infected persons and is strongly associated with initiation of antiretroviral therapy and viral suppression. However, it is unclear how retention in care and age interact to affect viral suppression. We evaluated whether the association between retention and viral suppression differed by age at entry into care. Methods: Cross-sectional analysis (2006-2010) involving 17,044 HIV-infected adults in 14 clinical cohorts across the United States and Canada. Patients contributed 1 year of data during their first full-calendar year of clinical observation. Poisson regression examined associations between retention measures [US National HIV/AIDS Strategy (NHAS), US Department of Health and Human Services (DHHS), 6-month gap, and 3-month visit constancy] and viral suppression (HIV RNA <= 200 copies/mL) by age group: 18-29 years, 30-39 years, 40-49 years, 50-59 years, and 60 years or older. Results: Overall, 89% of patients were retained in care using the NHAS measure, 74% with the DHHS indicator, 85% did not have a 6-month gap, and 62% had visits in 3-4 quarters of the year; 54% achieved viral suppression. For each retention measure, the association with viral suppression was significant for only the younger age groups (18-29 and 30-39 years): 18-29 years [adjusted prevalence ratio (APR) = 1.33, 95% confidence interval (CI): 1.03 to 1.70]; 30-39 years (APR = 1.23, 95% CI: 1.01 to 1.49); 40-49 years (APR = 1.06, 95% CI: 0.90 to 1.22); 50-59 (APR = 0.92, 95% CI: 0.75 to 1.13); >= 60 years (APR = 0.99, 95% CI: 0.63 to 1.56) using the NHAS measure as a representative example. Conclusions: These results have important implications for improving viral control among younger adults, emphasizing the crucial role retention in care plays in supporting viral suppression in this population.

引用

页码：413 / 419

页数：7