Treatment interruptions predict resistance in HIV-positive individuals purchasing fixed-dose combination antiretroviral therapy in Kampala, Uganda
Treatment interruptions predict resistance in HIV-positive individuals purchasing fixed-dose combination antiretroviral therapy in Kampala, Uganda
复制标题
DOI：
10.1097/qad.0b013e32802e6bfa
复制
发表时间：
2007-05-11
期刊：
影响因子：
3.8
通讯作者：
Bangsberg, David R.
中科院分区：
文献类型：
--
作者：
Oyugi, Jessica H.;Byakika-Tusiime, Jayne;Bangsberg, David R.
目的：为了评估患者购买抗逆转录病毒固定剂量复方制剂（FDC）therapeutic.Design的依从性，治疗中断和结局：97名参与者被招募到一个前瞻性的24周观察性队列研究的艾滋病毒阳性，抗逆转录病毒初治的个人开始自费Triomune或Maxivir治疗在坎帕拉，乌干达。通过每月的结构化访谈、未通知的家庭药丸计数和电子药物监测器（EMM）来测量依从性。治疗中断被测量为连续间隔大于48小时而不打开EMM。主要结果是生存与病毒抑制低于400拷贝/毫升，CD 4细胞的增加，和基因型药物耐药性在24 weeks.Results：中位基线CD 4细胞计数为56个细胞/亩和中位数标志拷贝RNA/毫升为5.54;平均粘附范围从82至95%的所有措施，但随着时间的推移显着下降。在一项意向治疗分析中，70名（72%）患者在第24周时血浆HIV-RNA水平检测不到。62/95例（65%）有连续EMM数据的个体治疗中断时间超过48小时。治疗中断占漏服剂量的90%。33名没有中断治疗超过48小时的参与者中没有一人出现耐药性，而62名中断治疗的参与者中有8名（13%）出现耐药性。抗逆转录病毒耐药被认为是在8%的个人和整体死亡率为10%，在24 weeks.Conclusion：HIV阳性的个人购买通用FDC抗逆转录病毒疗法的坚持和病毒抑制率高，抗逆转录病毒耐药率低，和强大的CD 4细胞反应。依从性是完全抑制病毒的生存率的重要预测因子。治疗中断是耐药性的重要预测因素。(C)2007年利平科特威廉姆斯&威尔金斯。
Objective: To evaluate adherence, treatment interruptions, and outcomes in patients purchasing antiretroviral fixed-dose combination (FDC) therapy.Design: Ninety-seven participants were recruited into a prospective 24-week observational cohort study of HIV-positive, anti retroviral-naive individuals initiating self-pay Triomune or Maxivir therapy in Kampala, Uganda. Adherence was measured by monthly structured interview, unannounced home pill count, and electronic medication monitors (EMM). Treatment interruptions were measured as continuous intervals greater than 48 h without opening the EMM. The primary outcomes were survival with viral suppression below 400 copies/ml, CD4 cell increases, and genotypic drug resistance at 24 weeks.Results: The median baseline CD4 cell count was 56 cells/mu l and median logo copies RNA/ml was 5.54; mean adherence ranged from 82 to 95% for all measures but declined significantly over time. In an intent-to-treat analysis, 70 (72%) patients had an undetectable plasma HIV-RNA level at week 24. Sixty-two of 95 (65%) individuals with continuous EMM data had a treatment interruption of greater than 48 h. Treatment interruptions accounted for 90% of missed doses. None of 33 participants who did not interrupt treatment for over 48 h had drug resistance, whereas eight of 62 (13%) participants who did interrupt therapy experienced drug resistance. Antiretroviral resistance was seen in 8% of individuals and overall mortality was 10% at 24 weeks.Conclusion: HIV-positive individuals purchasing generic FDC antiretroviral therapy have high rates of adherence and viral suppression, low rates of antiretroviral resistance, and robust CD4 cell responses. Adherence is an important predictor of survival with full viral suppression. Treatment interruptions are an important predictor of drug resistance. (C) 2007 Lippincott Williams & Wilkins.