A comparison study of multiple measures of adherence to HIV protease inhibitors
A comparison study of multiple measures of adherence to HIV protease inhibitors
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DOI：
10.7326/0003-4819-134-10-200105150-00011
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发表时间：
2001-05-15
影响因子：
39.2
通讯作者：
Wenger, NS
中科院分区：
文献类型：
--
作者：
Liu, HH;Golin, CE;Wenger, NS
背景：对HIV蛋白酶抑制剂的依从性差可能会影响治疗效果。很少有研究比较了测量依从性的方法，或将依从性测量与临床结局相关。目的：研究依从性的综合评分、依从性的三个主要测量指标和HIV病毒学应答之间的关系。设计：纵向队列研究。设置：公共HIV诊所。患者：108名接受蛋白酶抑制剂或非核苷类逆转录酶抑制剂治疗的HIV感染成年人接受了666个月的监测。用药事件监测系统（MEMS），药丸计数，并采访到一个复合坚持得分（CAS），和HIV viral load.Results：平均抗逆转录病毒坚持不同的坚持措施（MEMS，0.63;药丸计数，0.83;采访，0.93;和GAS，0.76）。随着时间的推移，复合依从性评分显著降低。复合依从性评分、MEMS值、药丸值和访谈值与开始治疗后6个月内达到不可检测的病毒载量在统计学上显著相关。复合依从性评分显示最强的预测关系（GAS、MEMS、药丸计数和访谈依从性增加10%的比值比分别为1.26 [95%CI，1.16至1.37]、1.13 [CI，1.06至1.21]、1.10 [CI，1.02至1.19]和1.35 [CI，结论：应用于同一患者的不同措施表明不同的依从性水平。MEMS可能低估了依从性，而药丸计数和访谈可能高估了依从性。结合多项指标的汇总指标与临床反应的相关性更强，但临床使用需要更实用的测量方法。
Background: Poor adherence to HIV protease inhibitors may compromise the effectiveness of treatment. Few studies have compared methods for measuring adherence or have related adherence measures to a clinical outcome.Objective: To examine the relationship among a composite score of adherence, the three primary measures of adherence, and HIV virologic response.Design: Longitudinal cohort study.Setting: Public HIV clinic.Patients: 108 HIV-infected adults receiving protease inhibitors or non-nucleoside reverse transcriptase inhibitors who were monitored for 666 monthly intervals.Measurements: Medication Event Monitoring System (MEMS), pill count, and interview combined into a composite adherence score (CAS), and HIV viral load.Results: Mean antiretroviral adherence differed by adherence measure (MEMS, 0.63; pill count, 0.83; interview, 0.93; and GAS, 0.76). Composite adherence score decreased significantly over time. Composite adherence score, MEMS values, pill values, and interview values were statistically significantly associated with achievement of an undetectable viral load within 6 months of initiating therapy. Composite adherence score showed the strongest predictive relationship (odds ratios for a 10% increase in adherence for GAS, MEMS, pill count and interview, respectively, were 1.26 [95% CI, 1.16 to 1.37], 1.13 [CI, 1.06 to 1.21], 1.10 [CI, 1.02 to 1.19], and 1.35 [CI, 0.93 to 1.94]).Conclusions: Different measures applied to the same patient suggest different levels of adherence. Adherence may be underestimated by MEMS and overestimated by pill count and interview. A summary measure combining several measures is more strongly related to a clinical response, but more practical measurement methods are needed for clinical use.