Doubts about DOT: antiretroviral therapy for resource-poor countries
Doubts about DOT: antiretroviral therapy for resource-poor countries
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DOI：
10.1097/00002030-200306130-00013
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发表时间：
2003-06-13
期刊：
影响因子：
3.8
通讯作者：
Bangsberg, DR
中科院分区：
文献类型：
--
作者：
Liechty, CA;Bangsberg, DR
简介：针对结核病（TB）开发的直接观察治疗方案已被建议作为在资源贫乏的国家提供艾滋病毒药物的模式，以确保依从性并防止耐药性。方法：根据对科学文献的审查，形成了关于直接观察结核病治疗方案中见证给药的有效性、在资源丰富和资源贫乏的环境中坚持艾滋病毒抗逆转录病毒治疗、依从性和HIV抗逆转录病毒药物耐药性，HIV病毒载量和HIV传播的风险之间的关系，以及与HIV和TB在资源贫乏的环境中相关的污名化问题。结果/结论：我们认为，对HIV直接观察治疗方案的热情是不成熟的，基于：模棱两可的证据表明，见证给药是上级自我管理的治疗;这些问题包括：资源贫乏的国家在坚持治疗方面是“特例”的错误假设;良好的坚持治疗对艾滋病毒耐药性可能产生的矛盾影响;抗逆转录病毒疗法在预防艾滋病毒传播方面未经证实的功效;以及每日抗逆转录病毒剂量可能带来的耻辱。(C)2003年利平科特威廉姆斯威尔金斯。
Introduction: Directly observed therapy programs developed for tuberculosis (TB) have been suggested as a model for the provision of HIV medications in resource-poor countries in order to ensure adherence and prevent drug resistance.Methods: Opinions were formed based on a review of scientific literature regarding the effectiveness of witnessed dosing in directly observed TB therapy programs, adherence to HIV antiretroviral therapy in resource-rich and resource-poor settings, relationship between adherence and HIV antiretroviral drug resistance, HIV viral load and risk of HIV transmission, and stigmatization concerns related to HIV and TB in resource-poor settings.Results/conclusions: We suggest that the enthusiasm for HIV directly observed therapy programs is premature based on: equivocal evidence that witnessed dosing is superior to self administered therapy; mistaken assumptions that resource-poor countries are a 'special case' with respect to adherence; possible paradoxical impact of good adherence on HIV drug resistance; unproven efficacy of antiretroviral therapy in preventing HIV transmission; and potential stigmatization of daily antiretroviral dosing. (C) 2003 Lippincott Williams Wilkins.