Adherence to drug-refill is a useful early warning indicator of virologic and immunologic failure among HIV patients on first-line ART in South Africa.
Adherence to drug-refill is a useful early warning indicator of virologic and immunologic failure among HIV patients on first-line ART in South Africa.
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DOI：
10.1371/journal.pone.0017518
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发表时间：
2011-03-09
期刊：
影响因子：
3.7
通讯作者：
Ekström AM
中科院分区：
文献类型：
--
作者：
El-Khatib Z;Katzenstein D;Marrone G;Laher F;Mohapi L;Petzold M;Morris L;Ekström AM
预防艾滋病毒患者一线治疗失败的负担得起的战略对于撒哈拉以南非洲抗逆转录病毒疗法的长期成功至关重要。世卫组织建议使用常规收集的数据，如坚持药物补充访问作为早期预警指标。我们研究了南非非核苷类逆转录酶抑制剂（NNRTI）接受者坚持药物补充访视与长期病毒学和免疫学失败之间的关系。2008年，在索韦托进行的一项回顾性队列研究中纳入了456例接受基于NNRTI的ART治疗的患者，中位时间为44个月（范围12-99个月; 1，510人-年）。在ART治疗前和治疗过程中对临床特征的图表进行了回顾。多变量逻辑回归和Kaplan-Meier生存分析评估了与病毒学（两次重复VL>50拷贝/ml）和免疫学失败（由WHO定义）的相关性。在接受ART中位数15个月后，19%（n = 88）和19%（n = 87）分别在病毒学和免疫学上失败。 药物补充就诊的累积依从性<95%与病毒学和免疫学失败显着相关（p<0.01）。在最终的多变量模型中，病毒学失败的风险因素为不完全依从性（OR 2.8，95%CI 1.2-6.7）和既往暴露于单剂量奈韦拉平或任何其他抗逆转录病毒药物（调整OR 2.1，95%CI 1.2-3.9），根据年龄和性别进行校正。在Kaplan-Meier分析中，第48个月时，依从和非依从患者的病毒学失败率分别为19%和37%（logrank p值= 0.02）。 五分之一的患者在ART治疗中位时间为15个月后病毒学失败。坚持药物补充访视可作为病毒学和免疫学失败的早期预警指标。
Affordable strategies to prevent treatment failure on first-line regimens among HIV patients are essential for the long-term success of antiretroviral therapy (ART) in sub-Saharan Africa. WHO recommends using routinely collected data such as adherence to drug-refill visits as early warning indicators. We examined the association between adherence to drug-refill visits and long-term virologic and immunologic failure among non-nucleoside reverse transcriptase inhibitor (NNRTI) recipients in South Africa. In 2008, 456 patients on NNRTI-based ART for a median of 44 months (range 12–99 months; 1,510 person-years) were enrolled in a retrospective cohort study in Soweto. Charts were reviewed for clinical characteristics before and during ART. Multivariable logistic regression and Kaplan-Meier survival analysis assessed associations with virologic (two repeated VL>50 copies/ml) and immunologic failure (as defined by WHO). After a median of 15 months on ART, 19% (n = 88) and 19% (n = 87) had failed virologically and immunologically respectively. A cumulative adherence of <95% to drug-refill visits was significantly associated with both virologic and immunologic failure (p<0.01). In the final multivariable model, risk factors for virologic failure were incomplete adherence (OR 2.8, 95%CI 1.2–6.7), and previous exposure to single-dose nevirapine or any other antiretrovirals (adj. OR 2.1, 95%CI 1.2–3.9), adjusted for age and sex. In Kaplan-Meier analysis, the virologic failure rate by month 48 was 19% vs. 37% among adherent and non-adherent patients respectively (logrank p value = 0.02). One in five failed virologically after a median of 15 months on ART. Adherence to drug-refill visits works as an early warning indicator for both virologic and immunologic failure.
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影响因子：
15.8
作者：
Keiser O;Orrell C;Egger M;Wood R;Brinkhof MW;Furrer H;van Cutsem G;Ledergerber B;Boulle A;Swiss HIV Cohort Study (SHCS) and the International Epidemiologic Databases to Evaluate AIDS in Southern Africa (IeDEA-SA)
通讯作者：
Swiss HIV Cohort Study (SHCS) and the International Epidemiologic Databases to Evaluate AIDS in Southern Africa (IeDEA-SA)
影响因子：
3.8
作者：
Jackson, JB;Becker-Pergola, G;Eshleman, SH
通讯作者：
Eshleman, SH
DOI：
10.1097/qad.0b013e32833a097b
发表时间：
2010-07-17
期刊：
AIDS (London, England)
影响因子：
--
作者：
El-Khatib Z;Ekstrom AM;Ledwaba J;Mohapi L;Laher F;Karstaedt A;Charalambous S;Petzold M;Katzenstein D;Morris L
通讯作者：
Morris L
影响因子：
11.8
作者：
Coovadia, Ashraf;Hunt, Gillian;Kuhn, Louise
通讯作者：
Kuhn, Louise
DOI：
10.1097/qad.0b013e32832ac34e
发表时间：
2009-06-01
期刊：
AIDS (London, England)
影响因子：
--
作者：
Hosseinipour MC;van Oosterhout JJ;Weigel R;Phiri S;Kamwendo D;Parkin N;Fiscus SA;Nelson JA;Eron JJ;Kumwenda J
通讯作者：
Kumwenda J