Effect of adherence to newly initiated antiretroviral therapy on plasma viral load
Effect of adherence to newly initiated antiretroviral therapy on plasma viral load
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DOI：
10.1097/00002030-200111090-00006
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发表时间：
2001-11-09
期刊：
影响因子：
3.8
通讯作者：
Strom, BL
中科院分区：
文献类型：
--
作者：
Gross, R;Bilker, WB;Strom, BL
目的：确定血浆病毒载量达到和未达到检测不到的受试者之间对新开始抗逆转录病毒治疗的依从性是否存在差异。设计：观察性队列研究，监测奈非那韦治疗最初 4 个月的依从性以及病毒学和免疫学参数。使用微电子监测系统（MEMS；APREX Corporation，门洛帕克，加利福尼亚州，美国）测量依从性。地点：三级护理中心的综合临床研究中心。参与者：41 名未使用过蛋白酶抑制剂、病毒载量 > 10000 拷贝/毫升的受试者，新开始包括奈非那韦在内的治疗方案，由费城 HIV 诊所转介。主要结果指标：主要结果是在使用奈非那韦后病毒载量无法检测到（< 50 拷贝/毫升）。 4个月。次要指标包括病毒载量和 CD4 细胞计数的变化。我们假设病毒载量达到不可检测的受试者的依从性会更高。结果：未检测到的受试者的依从性更高，他们服用了处方剂量的中位数 93% [四分位数范围 (IQR) 84-96%]，而可检测的受试者服用了中位数为 70% (IQR 46-93%)。依从性与病毒载量减少（Spearman's p = 0.38，P < 0.01）和 CD4 细胞计数增加（Spearman's p = 0.25，P = 0.06）相关。尽管治疗 4 个月期间各组之间存在差异，但第一个月的依从性没有差异 [未检测到，95% (IQR 88-98%) 与可检测到，94% (IQR 87-98%)，P > 0.50]。结论：依从性对于确定个体是否通过新开始的抗逆转录病毒治疗方案实现抑制非常重要。治疗第一个月后，依从性开始减弱。因此，对依从性进行更仔细的评估，尤其是在第一个月之后，非常重要。 (C) 2001 年利平科特威廉姆斯和威尔金斯。
Objective: To determine whether differences in adherence to newly initiated antiretroviral therapy exist between subjects who do and do not achieve undetectable plasma viral loads.Design: Observational cohort study monitoring adherence and virological and immunological parameters over the initial 4 months of therapy with nelfinavir. Adherence was measured using the microelectronic monitoring system (MEMS; APREX Corporation, Menlo Park, California, USA).Setting: General Clinical Research Center at a tertiary care center.Participants: Forty-one protease inhibitor-naive subjects with viral loads > 10000 copies/ml newly starting a regimen including nelfinavir, referred from HIV clinics in Philadelphia.Main outcome measures: The primary outcome was undetectable viral load (< 50 copies/ml) after 4 months. Secondary measures included changes in viral load and CD4 cell counts. We hypothesized that adherence would be greater in subjects who achieved undetectable viral loads.Results: Adherence was greater in undetectable subjects, who took a median of 93% of prescribed doses [interquartile range (IQR) 84-96%], whereas detectable subjects took a median of 70% (IQR 46-93%). Adherence correlated with viral load decrease (Spearman's p = 0.38, P < 0.01) and CD4 cell count increase (Spearman's p = 0.25, P = 0.06). Despite differences between the groups over 4 months of therapy, there were no adherence differences over the first month [undetectables, 95% (IQR 88-98% ) versus detectables, 94% (IQR 87-98%), P > 0.50].Conclusions: Adherence is important in determining whether or not individuals achieve suppression with a newly initiated antiretroviral regimen. Adherence begins to wane after the first month of therapy. Therefore, closer assessment of adherence particularly after this first month is important. (C) 2001 Lippincott Williams & Wilkins.