Antiretroviral failure despite high levels of adherence: discordant adherence-response relationship in Botswana.
Antiretroviral failure despite high levels of adherence: discordant adherence-response relationship in Botswana.
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DOI：
10.1097/qai.0b013e3181820141
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发表时间：
2008-09-01
期刊：
影响因子：
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通讯作者：
Gross R
中科院分区：
文献类型：
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作者：
Bisson GP;Rowh A;Weinstein R;Gaolathe T;Frank I;Gross R
虽然撒哈拉以南非洲的抗逆转录病毒治疗依从性可能较高，但在这种情况下维持病毒学抑制所需依从性的程度方面的知识有限。在博茨瓦纳哈博罗内启动高效抗逆转录病毒治疗（HAART）的HIV感染者中进行了病例对照研究。病例从接受HAART ≥6个月且血浆HIV-1 RNA水平（病毒载量）>1000拷贝/mL的受试者中随机选择。对照组随机选自HAART ≥6个月且所有病毒载量<400拷贝/mL的受试者。HAART依从性通过药房续药记录确定。共纳入302例患者;将57例患者与245例对照组进行非核苷类逆转录酶抑制剂HAART依从性水平的比较。使用药房再填充模式测量的中位依从性水平一直很高，但在病例组和对照组之间存在差异（病例组为91%，四分位距为83%-97%，对照组为97%，四分位距为91%-100%，P < 0.001，秩和检验）。依从性<95%与病毒学失败独立相关（比值比4.19，95%置信区间2.2 - 8.3）。在这种情况下，存在非常高的依从率，但仍然发生病毒学失败。未来的工作应探讨其他因素，可能解释治疗失败的设置高水平的依从性。
Although adherence to antiretroviral therapy may be higher in sub-Saharan Africa, knowledge regarding the magnitude of adherence needed to maintain virological suppression in this setting is limited. A case–control study among HIV-infected individuals initiating highly active antiretroviral therapy (HAART) in Gaborone, Botswana, was performed. Cases were randomly selected from subjects on HAART ≥6 months with plasma HIV-1 RNA levels (viral loads) >1000 copies/mL. Controls were randomly selected from subjects on HAART ≥6 months with all viral loads <400 copies/mL. HAART adherence was determined using pharmacy refill records. In total, 302 individuals were included; 57 cases were compared with 245 controls with respect to adherence levels on nonnucleoside reverse transcriptase inhibitor–based HAART. Median adherence levels, as measured using pharmacy refill patterns, were consistently high but differed among cases and controls (91%, interquartile range 83%–97% for cases vs 97%, interquartile range 91%–100% for controls, P < 0.001, rank-sum test). Adherence <95% was independently associated with virological failure (odds ratio 4.19, 95% confidence interval 2.2 to 8.3). Very high rates of adherence were present in this setting, yet virological failure occurred nonetheless. Future work should explore other factors that might explain treatment failure in the setting of high levels of adherence.