Not all missed doses are the same: sustained NNRTI treatment interruptions predict HIV rebound at low-to-moderate adherence levels.
Not all missed doses are the same: sustained NNRTI treatment interruptions predict HIV rebound at low-to-moderate adherence levels.
复制标题
DOI：
10.1371/journal.pone.0002783
复制
发表时间：
2008-07-30
期刊：
影响因子：
3.7
通讯作者：
Bangsberg, David R.
中科院分区：
文献类型：
--
作者：
Parienti, Jean-Jacques;Das-Douglas, Moupali;Massari, Veronique;Guzman, David;Deeks, Steven G.;Verdon, Renaud;Bangsberg, David R.
虽然对HIV强效抗逆转录病毒治疗的平均依从性之间的关系已经明确，但依从性分层中依从性模式之间的关系尚未研究。我们研究了药物事件监测系统（MEMS）定义的依从性模式及其与随后病毒学反弹的关系。我们从法国和北美的两个前瞻性队列中选择了既往接受非核苷类逆转录酶抑制剂（NNRTI）治疗至少3个月病毒学抑制的受试者。我们评估了病毒学反弹的风险，根据几种MEMS粘附测量，定义为HIV RNA>400拷贝/mL。研究了72例受试者，其中5例发生了病毒学反弹。发生和未发生病毒学反弹的受试者具有相似的基线特征，包括治疗持续时间、治疗方案（依法韦仑vs奈韦拉平）和给药方案。平均依从性每增加10%，病毒学反弹的风险降低（OR = 0.56; 95%可信区间（CI）[0.37，0.81]，P<0.002）。 最长治疗中断的每一个额外的连续停药日（OR = 1.34; 95%CI [1.15，1.68]，P<0.0001）和每一个额外的治疗中断超过2天（OR = 1.38; 95%CI [1.13，1.77]，P<0.002）都会增加病毒学反弹的风险。 在低至中度依从性（即<80%）的患者中，治疗中断持续时间（16.2天vs对照组6.1天，P<0.02）与病毒学反弹显著相关，但平均依从性（分别为53.1% vs 55.9%，P = 0.65）与病毒学反弹无关。 在低至中度依从性下，持续中断治疗可能比相同数量的间断漏服药物对NNRTI治疗造成更大的病毒反弹风险。
While the relationship between average adherence to HIV potent antiretroviral therapy is well defined, the relationship between patterns of adherence within adherence strata has not been investigated. We examined medication event monitoring system (MEMS) defined adherence patterns and their relation to subsequent virologic rebound. We selected subjects with at least 3-months of previous virologic suppression on a non-nucleoside reverse transcriptase inhibitor (NNRTI)-based regimen from two prospective cohorts in France and North America. We assessed the risk of virologic rebound, defined as HIV RNA of >400 copies/mL according to several MEMS adherence measurements. Seventy two subjects were studied, five of them experienced virologic rebound. Subjects with and without virologic rebound had similar baseline characteristics including treatment durations, regimen (efavirenz vs nevirapine), and dosing schedule. Each 10% increase in average adherence decreased the risk of virologic rebound (OR = 0.56; 95% confidence interval (CI) [0.37, 0.81], P<0.002). Each additional consecutive day off therapy for the longest treatment interruption (OR = 1.34; 95%CI [1.15, 1.68], P<0.0001) and each additional treatment interruption for more than 2 days (OR = 1.38; 95%CI [1.13, 1.77], P<0.002) increased the risk of virologic rebound. In those with low-to-moderate adherence (i.e. <80%), treatment interruption duration (16.2 days versus 6.1 days in the control group, P<0.02), but not average adherence (53.1% vs 55.9%, respectively, P = 0.65) was significantly associated with virologic rebound. Sustained treatment interruption may pose a greater risk of virologic rebound on NNRTI therapy than the same number of interspersed missed doses at low-to-moderate adherence.
登录
查看更多内容
影响因子：
--
作者：
Cohen, Calvin J.;Colson, Amy E.;Morse, Gene D.
通讯作者：
Morse, Gene D.
影响因子：
6.4
作者：
Dybul, M;Nies-Kraske, E;Fauci, AS
通讯作者：
Fauci, AS
影响因子：
3.8
作者：
Bangsberg, DR;Perry, S;Moss, A
通讯作者：
Moss, A
影响因子：
158.5
作者：
Riddler, Sharon A.;Haubrich, Richard;Mellors, John W.
通讯作者：
Mellors, John W.
影响因子：
11.8
作者：
Maggiolo, F;Ravasio, L;Suter, F
通讯作者：
Suter, F