Global estimates of viral suppression in children and adolescents and adults on antiretroviral therapy adjusted for missing viral load measurements: a multiregional, retrospective cohort study in 31 countries,The Lancet HIV

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Global estimates of viral suppression in children and adolescents and adults on antiretroviral therapy adjusted for missing viral load measurements: a multiregional, retrospective cohort study in 31 countries
The Lancet HIV ( IF 12.8 ) Pub Date : 2021-11-29 , DOI: 10.1016/s2352-3018(21)00265-4
Win Min Han ₁ , Matthew G Law ₂ , Matthias Egger ₃ , Kara Wools-Kaloustian ₄ , Richard Moore ₅ , Catherine McGowan ₆ , Nagalingesawaran Kumarasamy ₇ , Sophie Desmonde ₈ , Andrew Edmonds ₉ , Mary-Ann Davies ₁₀ , Constantin Yiannoutsos ₁₁ , Keri N Althoff ₁₂ , Claudia P Cortes ₁₃ , Thahira Jamal Mohamed ₁₄ , Antoine Jaquet ₁₅ , Kathryn Anastos ₁₆ , Jonathan Euvrard ₁₀ , Barbara Castelnuovo ₁₇ , Kate Salters ₁₈ , Lara Esteves Coelho ₁₉ , Didier K Ekouevi ₂₀ , Brian Eley ₂₁ , Lameck Diero ₂₂ , Elizabeth Zaniewski ₂₃ , Nathan Ford ₂₄ , Annette H Sohn ₂₅ , Azar Kariminia ₂ ,

Affiliation

The Kirby Institute, UNSW Sydney, Sydney, NSW, Australia; HIV-NAT, Thai Red Cross AIDS Research Centre, Bangkok, Thailand.
The Kirby Institute, UNSW Sydney, Sydney, NSW, Australia.
Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland; Center for Infectious Disease Epidemiology and Research, School of Public Health and Family Medicine, University of Cape Town, Cape Town, South Africa.
Department of Medicine, Indiana University, Indianapolis, IN, USA.
School of Medicine, Johns Hopkins University, Baltimore, MD, USA.
Division of Infectious Diseases, Vanderbilt University Medical Center, Nashville, TN, USA.
Chennai Antiviral Research and Treatment Clinical Research Site, The Voluntary Health Services, Chennai, India.
INSERM U1027, Toulouse III University, Toulouse, France.
Department of Epidemiology, The University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.
Center for Infectious Disease Epidemiology and Research, School of Public Health and Family Medicine, University of Cape Town, Cape Town, South Africa.
RM Fairbanks School of Public Health, Indiana University, Indianapolis, IN, USA.
Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA.
Fundación Arriaran-Facultad de Medicina Universidad de Chile, Santiago, Chile.
Pediatric Institute, Hospital Kuala Lumpur, Kuala Lumpur, Malaysia.
University of Bordeaux, Inserm, French National Research Institute for Sustainable Development, UMR 1219, Bordeaux, France.
Department of Medicine, Albert Einstein College of Medicine, Bronx, NY, USA.
Infectious Diseases Institute, Makerere University, Kampala, Uganda.
British Columbia Centre for Excellence in HIV/AIDS, St Paul's Hospital, Vancouver, BC, Canada.
Instituto Nacional de Infectologia Evandro Chagas, Fundação Oswaldo Cruz, Rio de Janeiro, Brazil.
Program PAC-CI, Abidjan, Côte d'Ivoire; Bordeaux Population Health (UMR1219), Bordeaux, France.
Red Cross War Memorial Children's Hospital, University of Cape Town, Cape Town, South Africa; Department of Paediatrics and Child Health, University of Cape Town, Cape Town, South Africa.
Department of Medicine, Moi University School of Medicine and Moi Teaching and Referral Hospital, Eldoret, Kenya.
Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland.
Center for Infectious Disease Epidemiology and Research, School of Public Health and Family Medicine, University of Cape Town, Cape Town, South Africa; HIV/AIDS Department and Global Hepatitis Program, WHO, Geneva, Switzerland.
TREAT Asia/amfAR, The Foundation for AIDS Research, Bangkok, Thailand.

Background

As countries move towards the UNAIDS's 95-95-95 targets and with strong evidence that undetectable equals untransmittable, it is increasingly important to assess whether those with HIV who are receiving antiretroviral therapy (ART) achieve viral suppression. We estimated the proportions of children and adolescents and adults with viral suppression at 1, 2, and 3 years after initiating ART.

Methods

In this retrospective cohort study, seven regional cohorts from the International epidemiology Databases to Evaluate AIDS (IeDEA) consortium contributed data from individuals initiating ART between Jan 1, 2010, and Dec 31, 2019, at 148 sites in 31 countries with annual viral load monitoring. Only people with HIV who started ART after the time a site started routine viral load monitoring were included. Data up to March 31, 2020, were analysed. We estimated the proportions of children and adolescents (aged <18 years at ART initiation) and adults (aged ≥18 years at ART initiation) with viral suppression (viral load <1000 copies per mL) at 1, 2, and 3 years after ART initiation using an intention-to-treat approach and an adjusted approach that accounted for missing viral load measurements.

Findings

21 594 children and adolescents (11 812 [55%] female, 9782 [45%] male) from 106 sites in 22 countries and 255 662 adults (163 831 [64%] female, 91 831 [36%] male) from 143 sites in 30 countries were included. Using the intention-to-treat approach, the proportion of children and adolescents with viral suppression was 7303 (36%) of 20 478 at 1 year, 5709 (30%) of 19 135 at 2 years, and 4287 (24%) of 17 589 at 3 years after ART initiation; the proportion of adults with viral suppression was 106 541 (44%) of 240 600 at 1 year, 79 141 (36%) of 220 925 at 2 years, and 57 970 (29%) of 201 124 at 3 years after ART initiation. After adjusting for missing viral load measurements among those who transferred, were lost to follow-up, or who were in follow-up without viral load testing, the proportion of children and adolescents with viral suppression was 12 048 (64% [plausible range 43–81]) of 18 835 at 1 year, 10 796 (62% [41–77]) of 17 553 at 2 years, and 9177 (59% [38–91]) of 15 667 at 3 years after ART initiation; the proportion of adults with viral suppression was 176 964 (79% [53–80]) of 225 418 at 1 year, 145 552 (72% [48–79]) of 201 238 at 2 years, and 115 260 (65% [43–69]) of 178 458 at 3 years after ART initiation.

Interpretation

Although adults with HIV are approaching the global target of 95% viral suppression, progress among children and adolescents is much slower. Substantial efforts are still needed to reach the viral suppression target for children and adolescents.

Funding

US National Institutes of Health.

中文翻译：

根据缺失的病毒载量测量值调整儿童、青少年和成人抗逆转录病毒治疗病毒抑制的全球估计：在 31 个国家进行的多区域回顾性队列研究

背景

随着各国朝着联合国艾滋病规划署的 95-95-95 目标迈进，并且有强有力的证据表明不可检测等于不可传播，评估正在接受抗逆转录病毒治疗 (ART) 的艾滋病毒感染者是否实现病毒抑制变得越来越重要。我们估计了开始 ART 后 1 年、2 年和 3 年时病毒受到抑制的儿童、青少年和成人的比例。

方法

在这项回顾性队列研究中，国际艾滋病评估流行病学数据库 (IeDEA) 联盟的 7 个区域队列提供了 2010 年 1 月 1 日至 2019 年 12 月 31 日期间在 31 个国家的 148 个地点开始接受抗逆转录病毒治疗的个人的数据，并进行了年度病毒载量监测。仅包括在站点开始常规病毒载量监测后开始抗逆转录病毒治疗的艾滋病毒感染者。分析了截至 2020 年 3 月 31 日的数据。我们估计了 ART 后 1 年、2 年和 3 年时获得病毒抑制（病毒载量 <1000 拷贝/毫升）的儿童和青少年（开始 ART 时年龄 <18 岁）和成人（开始 ART 时年龄≥18 岁）的比例使用意向治疗方法和考虑到缺失的病毒载量测量的调整方法开始。

发现

来自 22 个国家 106 个地点的 21 594 名儿童和青少年（11 812 [55%] 女性，9782 [45%] 男性）和来自 143 个国家的 255 662 名成人（163 831 [64%] 女性，91 831 [36%] 男性）包括 30 个国家的站点。采用意向治疗方法，1 年时病毒抑制的儿童和青少年比例为 20 478 人中的 7303 人（36%），2 年时为 19 135 人中的 5709 人（30%），2 年时为 4287 人（24%）。开始 ART 后 3 年为 17 589；开始 ART 后 1 年，病毒抑制的成人比例为 240 600 人中的 106 541 人（44%），2 年时 220 925 人中的 79 141 人（36%），以及 3 年时 201 124 人中的 57 970 人（29%）。在对转学、失访或未进行病毒载量检测的随访者中缺失的病毒载量测量进行调整后，病毒抑制的儿童和青少年比例为 12 048 人（64% [合理范围 43]）。 –81]）在 1 年时为 18 835 例，在 2 年时为 17 553 例中为 10 796 例（62% [41-77]），在 ART 开始后 3 年为 15 667 例中为 9177 例（59% [38-91]）； 1 年时，病毒抑制的成人比例为 225 418 人中的 176 964 人（79% [53–80]），2 年时为 201 238 人中的 145 552 人（72% [48–79]），2 年时为 115 260 人（65%） [43-69]），共 178 458 人，在 ART 开始 3 年后。