Impact of immune reconstitution inflammatory syndrome on antiretroviral therapy adherence.
Impact of immune reconstitution inflammatory syndrome on antiretroviral therapy adherence.
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DOI：
10.2147/ppa.s38897
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发表时间：
2012
影响因子：
2.2
通讯作者：
Maartens G
中科院分区：
文献类型：
--
作者：
Nachega JB;Morroni C;Chaisson RE;Goliath R;Efron A;Ram M;Maartens G
我们确定了免疫重建炎症综合征（IRIS）对抗逆转录病毒治疗（ART）依从性的影响，在一个队列中的274名人类免疫缺陷病毒（HIV）感染的南非成年人开始ART。我们进行了二次分析的数据，从一个随机对照试验的部分监督ART在开普敦，南非。记录每月服药计数依从性、病毒抑制（HIV病毒载量< 50 c/mL）和IRIS事件。Poisson回归用于确定ART治疗前6个月ART依从性低于中位数的相关变量。我们招募了274例患者：58%为女性，中位年龄34岁，中位CD 4计数98个细胞/μL，46%为世界卫生组织临床IV期，40%为结核病（TB）治疗。IRIS和TB-IRIS的发生率分别为8.4%和6.6%。发生IRIS事件与未发生IRIS的患者6个月时的中位累积依从性分别为95.5%与98.2%（P = 0.04）。虽然没有统计学意义，但发生IRIS的患者6个月的病毒载量抑制低于未发生IRIS的患者（68% vs 80%，P = 0.32）。ART依从性低于中位数98%与酒精滥用（相对风险[RR] 1.5; 95%置信区间[CI] 1.2-1.9; P = 0.003）和IRIS事件（RR 1.7; 95% CI 1.2-2.2; P = 0.001）独立相关。尽管IRIS事件与依从率略低相关，但在本研究人群中，ART的总体依从性仍然很高。对IRIS的担忧不应该阻止临床医生早期开始ART。
We determined the impact of immune reconstitution inflammatory syndrome (IRIS) on antiretroviral therapy (ART) adherence in a cohort of 274 human immunodeficiency virus (HIV)-infected South African adults initiating ART. We carried out a secondary analysis of data from a randomized controlled trial of partially supervised ART in Cape Town, South Africa. Monthly pill count adherence, viral suppression (HIV viral load < 50 c/mL), and IRIS events were documented. Poisson regression was used to identify variables associated with ART adherence below the median in the first 6 months of ART. We enrolled 274 patients: 58% women, median age 34 years, median CD4 count 98 cells/μL, 46% World Health Organization clinical stage IV, and 40% on treatment for tuberculosis (TB). IRIS and TB-IRIS developed in 8.4% and 6.6% of patients, respectively. The median cumulative adherence at 6 months for those with an IRIS event vs no IRIS was 95.5% vs 98.2% (P = 0.04). Although not statistically significant, patients developing IRIS had a lower 6-month viral load suppression than those without IRIS (68% vs 80%, P = 0.32). ART adherence below the median of 98% was independently associated with alcohol abuse (relative risk [RR] 1.5; 95% confidence interval [CI] 1.2–1.9; P = 0.003) and IRIS events (RR 1.7; 95% CI 1.2–2.2; P = 0.001). Although IRIS events were associated with slightly lower adherence rates, overall adherence to ART remained high in this study population. Concerns about IRIS should not deter clinicians from early ART initiation.