Differential adherence to combination antiretroviral therapy is associated with virological failure with resistance
Differential adherence to combination antiretroviral therapy is associated with virological failure with resistance
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DOI：
10.1097/qad.0b013e3282f366ff
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发表时间：
2008-01-02
期刊：
影响因子：
3.8
通讯作者：
Mannheimer, Sharon B.
中科院分区：
文献类型：
--
作者：
Gardner, Edward A.;Sharma, Shweta;Mannheimer, Sharon B.
目的：研究联合抗逆转录病毒治疗中不同药物依从性的发生情况，并评估其预测因子以及与病毒学失败和抗逆转录病毒药物耐药的相关性。设计：前瞻性临床试验数据的二次分析。灵活的初始逆转录病毒抑制疗法研究（艾滋病临床研究社区项目058）是一项比较非核苷类逆转录酶抑制剂（NNRTI）与蛋白酶抑制剂（PI）的随机试验与NNRTI加PI为基础的抗逆转录病毒治疗（三级）在治疗初治的HIV-1感染者。在第1个月和第4个月评估依从性，然后每4个月评估一次。不同的依从性，定义为同一时间点自我报告的个体抗逆转录病毒药物依从性水平的任何差异，在多变量考克斯回归分析中作为二元时间更新变量进行评估，分析至初始病毒学失败的时间（HIV-RNA > 1000拷贝/ml）和初始病毒学失败伴基因型抗逆转录病毒耐药。在超过60个月的中位随访中，1379名参与者中有403名（29%）至少报告了一次依从性差异。随机分配到三类策略（35%）的参与者比NNRTI（28%）或PI（25%）策略（P=0.005）更常报告差异依从性，但与人口统计学或基线疾病特异性因素无关。在那些报告不同依从性的患者中，146例（36%）在初始病毒学失败之前报告。这些参与者的初始病毒学失败和初始病毒学失败与抗逆转录病毒耐药的风险增加，与参与者没有差异的坚持之前，初始virological failure.Conclusion：差异的坚持通常报告，并与初始病毒学失败和初始病毒学失败与抗逆转录病毒耐药的风险增加。(c)2008年威科健康。
Objectives: To investigate the occurrence of differential adherence to components of combination antiretroviral therapy and assess its predictors and association with virological failure and antiretroviral medication resistance.Design: A secondary analysis of prospective clinical trial data.Methods: The Flexible Initial Retrovirus Suppressive Therapies study (Community Programs for Clinical Research on AIDS 058) was a randomized trial comparing non-nucleoside reverse transcriptase inhibitor (NNRTI) versus protease inhibitor (PI) versus NNRTI plus PI-based (three-class) antiretroviral therapy in treatment-naive HIV-1-infected individuals. Adherence was assessed at months 1 and 4, and then every 4 months. Differential adherence, defined as any difference in self-reported level of adherence to individual antiretroviral medications at the same timepoint, was evaluated as a binary time-updated variable in multivariate Cox regression analyses of time to initial virological failure (HIV-RNA > 1000 copies/ml) and initial virological failure with genotypic antiretroviral resistance.Results: Differential adherence was reported at least once by 403 of 1379 participants (29%), over 60 months median follow-up. Differential adherence was more commonly reported by participants randomly assigned to the three-class strategy (35%) than the NNRTI (28%) or PI (25%) strategies (P=0.005), but was not associated with demographic or baseline disease-specific factors. Of those reporting differential adherence, 146 (36%) reported it before initial virological failure. These participants had an increased risk of initial virological failure and initial virological failure with antiretroviral resistance compared with participants without differential adherence before initial virological failure.Conclusion: Differential adherence was commonly reported and was associated with an increased risk of initial virological failure and initial virological failure with antiretroviral resistance. (c) 2008 Wolters Kluwer Health.