Universal test and treat is not associated with sub-optimal antiretroviral therapy adherence in rural South Africa: the ANRS 12249 TasP trial
Universal test and treat is not associated with sub-optimal antiretroviral therapy adherence in rural South Africa: the ANRS 12249 TasP trial
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DOI：
10.1002/jia2.25112
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发表时间：
2018-06-11
影响因子：
6
通讯作者：
Porter, Kholoud
中科院分区：
文献类型：
--
作者：
Iwuji, Collins;McGrath, Nuala;Porter, Kholoud
简介：艾滋病毒治疗指南现在建议开始抗逆转录病毒治疗（ART），无论CD 4计数如何，以最大限度地造福个人和社会。目前尚不清楚在较高的CD 4计数下开始ART是否会影响依从性水平。我们调查了在较高的CD 4计数下开始ART是否与次优依从性相关（=研究结束前12个月，ART开始时的中位数（IQR）CD 4为350 qcells/mm（3）（234，503）;中位数年龄为34.6岁（IQR 27.4至46.4），71.7%为女性。通过VAS和PC测量的依从性分别为14.7%和20.7%。在粗分析中和调整潜在混杂因素后，粘附性与ART启动时的CD 4计数无显著相关性（CD 4计数每增加100个细胞/mm（3），次优粘附性线性趋势的调整OR：VAS为1.00，95% CI 0.95 - 1.05，PC为1.03，95% CI 0.99 - 1.07）。12个月时病毒学抑制率为97%。两种方法的最佳依从性与病毒学抑制显著相关（VAS p < 0.001; PC p = 0.006）。结论：我们没有发现任何证据表明在ART开始时较高的CD 4计数与前12个月的次优ART依从性相关。我们的研究结果应该减轻对在较高CD 4计数下开始ART的个体的依从性的担忧，但需要长期结果。
Introduction: HIV treatment guidelines now recommend antiretroviral therapy (ART) initiation regardless of CD4 count to maximize benefit both for the individual and society. It is unknown whether the initiation of ART at higher CD4 counts would affect adherence levels. We investigated whether initiating ART at higher CD4 counts was associated with sub-optimal adherence (= 12 months before study end, median (IQR) CD4 at ART initiation was 350 qcells/mm(3) (234, 503); median age was 34.6 years (IQR 27.4 to 46.4) and 71.7% were female. Adherence was sub-optimal in 14.7% of visits as measured by VAS and 20.7% by PC. In both the crude analyses and after adjusting for potential confounders, adherence was not significantly associated with CD4 count at ART initiation (adjusted OR for linear trend in suboptimal adherence with every 100 cells/mm(3) increase in CD4 count: 1.00, 95% CI 0.95 to 1.05, for VAS, and 1.03, 95% CI 0.99 to 1.07, for PC). Virological suppression at 12 months was 97%. Optimal adherence by both measures was significantly associated with virological suppression (p < 0.001 for VAS; p = 0.006 for PC).Conclusions: We found no evidence that higher CD4 counts at ART initiation were associated with sub-optimal ART adherence in the first 12 months. Our findings should alleviate concerns about adherence in individuals initiating ART at higher CD4 counts, however long-term outcomes are needed.