Frequency of HIV-1 Viral Load Monitoring of Patients Initially Successfully Treated with Combination Antiretroviral Therapy 英文参考文献.docVIP

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Frequency of HIV-1 Viral Load Monitoring of Patients Initially Successfully Treated with Combination Antiretroviral Therapy 英文参考文献.doc

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Frequency of HIV-1 Viral Load Monitoring of Patients Initially Successfully Treated with Combination Antiretroviral Therapy 英文参考文献

FrequencyofHIV-1ViralLoadMonitoringofPatients InitiallySuccessfullyTreatedwithCombination AntiretroviralTherapy VanjaRomih1,SnjezˇanaZidovecˇ Lepej1,KornelijaGedike1,DavorkaLukas1,JosipBegovac1,2* 1UniversityHospitalforInfectiousDiseases,Zagreb,Croatia,2DepartmentofInfectiousDiseases,UniversityofZagrebSchoolofMedicine,Zagreb,Croatia Abstract Background: Although considered an essential tool for monitoring the effect of combination antiretroviral treatment (CART),HIV-1RNA(viralload,VL)testingisgreatlyinfluencedbycostandavailabilityofresources. Objectives:ToexaminewhetherHIVinfectedpatientswhowereinitiallysuccessfullytreatedwithCARThavelessfrequent monitoring of VL over time and whether CART failure and other HIV-disease and sociodemographic characteristics are associatedwithlessfrequentVLtesting. Methods:ThestudyincludedpatientswhostartedCARTintheperiod1999–2004,wereolderthan18years,CARTnaive, hadtwoconsecutiveviralloadmeasurementsof,400copies/mlafter5monthsoftreatmentandhadcontinuousCART duringthefirst15months.Thetimebetweentwoconsecutivevisits(days)wastheoutcomeandassociatedfactorswere assessedusinglinearmixedmodels. Results:Weanalyzedatotalof128patientswith1683visitsthroughDecember2009.CARTfailurewasobservedin31(24%) patients. When adjusted for the follow-up time, the mean interval between two consecutive VL tests taken in patients beforeCARTfailure(155.2days)wasalmostidenticaltotheintervaltakeninpatientswhodidnotfailCART(155.3days).On multivariableanalysis,wefoundthattheadjustedestimatedtimebetweenvisitswas150.9daysbefore2003and177.6in 2008/2009.Alongertimebetweenvisitswasobservedinseafarerscomparedtonon-seafarers;themeandifferencewas 30.7days(95%CI,14.0to47.4;p,0.001);andinindividualswholivedmorethan160kilometersfromtheHIVtreatment center(meandifference,16days,p=0.010). Conclusions: Less frequent monitoring of VL became common in recent years and was not associated with failure. We identifiedseafarersasapopulationwithspecialneedsforCARTmonitoringanddeli