Timeliness of clinic attendance is a good predictor of virological response and resistance to antiretroviral drugs in HIV-infected patients.
Timeliness of clinic attendance is a good predictor of virological response and resistance to antiretroviral drugs in HIV-infected patients.
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DOI：
10.1371/journal.pone.0049091
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发表时间：
2012
期刊：
影响因子：
3.7
通讯作者：
Pujades-Rodriguez M
中科院分区：
文献类型：
--
作者：
Bastard M;Pinoges L;Balkan S;Szumilin E;Ferreyra C;Pujades-Rodriguez M
确保长期坚持治疗对于艾滋病毒治疗的成功至关重要。由于在资源有限的情况下很难获得病毒载量监测和基因分型，因此需要一种简单的工具来监测依从性。我们评估了基于就诊及时性和病毒学反应与HIV耐药性的指标之间的关系。收集了7项病毒学横断面研究的数据。依从性指标的计算方法是，将参加延迟治疗的预约次数除以开始抗逆转录病毒治疗(ART)与病毒学检测日期之间的月数，再乘以100。依次考虑延迟1天或以上至5天或更长时间。分别对成人和儿童进行多变量随机截距Logistic回归分析，以检验其对预后的影响。共纳入3580名成人和253名儿童。成人被跟踪的中位数为26.0个月(IQR 12.8-45.0)，并接受了24次访问(IQR 13-34)。1天延迟依从性指标与病毒载量抑制(OR 0.96，95%CI 0.95~0.97每单位增加)、病毒学失败(OR 1.05，95%CI 1.03~1.06)和HIV耐药性(OR 1.03，95%CI 1.01~1.05)密切相关，调整了初始年龄和CD4计数、既往ART经验、方案类型和治疗开始时诊断的结核病。在儿童中也观察到了类似的结果。基于就诊及时性的依从性指标可以强烈预测病毒学反应和耐药性，并有助于在无法监测病毒载量的情况下及时识别未依从性患者。
Ensuring long-term adherence to therapy is essential for the success of HIV treatment. As access to viral load monitoring and genotyping is poor in resource-limited settings, a simple tool to monitor adherence is needed. We assessed the relationship between an indicator based on timeliness of clinic attendance and virological response and HIV drug resistance. Data from 7 virological cross-sectional studies were pooled. An adherence indicator was calculated as the number of appointments attended with delay divided by the number of months between antiretroviral treatment (ART) initiation and date of virological testing and multiplying this by 100. Delays of 1 or more to 5 or more days were considered in turn. Multivariate random-intercept logistic regression was fitted to examine the effect on outcomes, separately for adults and children. A total of 3580 adults and 253 children were included. Adults were followed for a median of 26.0 months (IQR 12.8-45.0) and attended a median of 24 visits (IQR 13–34). The 1-day delay adherence indicator was strongly associated with viral load suppression (OR 0.96, 95% CI 0.95–0.97 per unit increase), virological failure (OR 1.05, 95% CI 1.03–1.06) and HIV drug resistance (OR 1.03, 95% CI 1.01–1.05) after adjusting for initial age and CD4 count, previous ART experience, type of regimen and Tuberculosis diagnosis at start of therapy. Similar results were observed in children. An adherence indicator based on timeliness of clinic attendance predicts strongly both virological response and drug resistance, and could help to timely identify non-adherent patients in settings where viral load monitoring is not available.
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影响因子：
15.8
作者：
Mills EJ;Nachega JB;Bangsberg DR;Singh S;Rachlis B;Wu P;Wilson K;Buchan I;Gill CJ;Cooper C
通讯作者：
Cooper C
影响因子：
11.8
作者：
Ivers, LC;Kendrick, D;Doucette, K
通讯作者：
Doucette, K
影响因子：
3.8
作者：
Bangsberg, DR;Perry, S;Moss, A
通讯作者：
Moss, A
DOI：
10.1097/qai.0b013e31819675e9
发表时间：
2009-04-15
期刊：
Journal of acquired immune deficiency syndromes (1999)
影响因子：
--
作者：
Lima VD;Harrigan R;Bangsberg DR;Hogg RS;Gross R;Yip B;Montaner JS
通讯作者：
Montaner JS
影响因子：
3.7
作者：
El-Khatib Z;Katzenstein D;Marrone G;Laher F;Mohapi L;Petzold M;Morris L;Ekström AM
通讯作者：
Ekström AM