Short term adherence tool predicts failure on second line protease inhibitor-based antiretroviral therapy: an observational cohort study
Short term adherence tool predicts failure on second line protease inhibitor-based antiretroviral therapy: an observational cohort study
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DOI：
10.1186/s12879-014-0664-3
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发表时间：
2014-12-04
影响因子：
3.7
通讯作者：
Maartens, Gary
中科院分区：
文献类型：
--
作者：
Court, Richard;Leisegang, Rory;Maartens, Gary
背景资料：在中低收入国家，大多数二线抗逆转录病毒治疗（ART）失败的病毒学失败（VF）患者是由于依从性差，而不是抗逆转录病毒耐药性。一个简单的坚持工具，旨在检测VF将节省资源，合理限制需要病毒载量（VL）检测，并在这些国家与访问三线ART，需要耐药testing.Methods：我们进行了观察性队列研究的患者谁开始在夸祖鲁-纳塔尔，南非的诊所二线ART。使用从诊所电子数据库中提取的临床和药房再填充数据，我们确定了VF的风险因素。评价了三种不同的计算短期药房续药依从性的方法，并与二线治疗开始后的长期依从性进行了比较。我们还探索了短期药房续药的不同持续时间预测二线ART中VF的能力。结果：我们纳入了274名患者，平均随访时间为27个月，接受二线抗逆转录病毒治疗，室颤率在3%至16%之间在开始二线ART治疗后每6个月间隔内，对243例二线治疗4个月后至少有1例VL的患者进行了统计学分析，分析.在较短时间内（4至6个月）评估的药房续药依从性预测病毒学抑制，以及在较长时间内评估的药房续药。VF的风险下降73%，在4个月的时间内，从药房补充测量的依从性每增加10%。低CD4计数在二线ART启动是一个显着的独立危险因素VF。结论：患者确定为不遵守短期药房笔芯的风险VF二线ART。这种务实的遵守工具，可以帮助确定患者需要遵守干预措施，并帮助合理使用VL监测和耐药测试二线ART患者。
Background: Most patients who experience virologic failure (VF) on second line antiretroviral therapy (ART) in low-middle income countries fail due to poor adherence rather than antiretroviral resistance. A simple adherence tool designed to detect VF would conserve resources by rationally limiting need for viral load (VL) testing and, in those countries with access to third line ART, the need for resistance testing.Methods: We conducted an observational cohort study of patients who initiated second line ART at a clinic in Kwazulu-Natal, South Africa. Using clinical and pharmacy refill data extracted from the clinic's electronic database, we determined risk factors for VF. Three different methods of calculating short term pharmacy refill adherence were evaluated and compared with long term adherence since second line initiation. We also explored the ability of differing durations of short term pharmacy refill to predict VF on second line ART.Results: We included 274 patients with a median follow up of 27 months on second line ART. VF ranged between 3% and 16% within each six month interval after initiating second line ART. 243 patients with at least one VL after 4 months on second line were analysed in the statistical analysis. Pharmacy refill adherence assessed over shorter periods (4 to 6 months) predicted virologic suppression as well as pharmacy refill assessed over longer periods. The risk of VF fell 73% with each 10% increase in adherence measured from pharmacy refills over a 4 month period. Low CD4 count at second line ART initiation was a significant independent risk factor for VF.Conclusion: Patients identified as poorly adherent by short term pharmacy refill are at risk for VF on second line ART. This pragmatic adherence tool could assist in identifying patients who require adherence interventions, and help rationalize use of VL monitoring and resistance testing among patients on second line ART.