Adherence, virological and immunological outcomes for HIV-infected veterans starting combination antiretroviral therapies
Adherence, virological and immunological outcomes for HIV-infected veterans starting combination antiretroviral therapies
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DOI：
10.1097/qad.0b013e3281532b31
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发表时间：
2007-07-31
期刊：
影响因子：
3.8
通讯作者：
Justice, Amy C.
中科院分区：
文献类型：
--
作者：
Braithwaite, R. Scott;Kozal, Michael J.;Justice, Amy C.
目标：我们的目的是确定开始第一个联合抗逆转录病毒治疗 (ART) 方案一年后的依从性、病毒学和免疫学结果。行政、实验室和药房数据的综合。抗逆转录病毒治疗方案分为依非韦伦、奈韦拉平、加强蛋白酶抑制剂 (PI) 和单一 PI 类别。倾向评分用于控制治疗分配的混淆。根据药房补充记录估计依从性。地点：退伍军人事务医疗保健系统，所有地点。参与者：开始联合 ART 且之前接受过抗逆转录病毒治疗的可能性较低的 HIV 感染者。干预措施：无。结果：按处方配药的抗逆转录病毒处方比例、HIV-RNA 日志变化、HIV-RNA 病毒抑制日志比例、CD4 细胞计数变化。结果：共有 6394 名个体不太可能以前曾接受过抗逆转录病毒治疗，并在 1996 年至 2004 年间开始联合 ART，并且有资格进行分析。总体依从性较低（63% 的处方按处方配药），依非韦伦 (67%) 和奈韦拉平 (65%) 方案的依从性显着高于强化 PI (59%) 或单一 PI (61%) 方案的依从性 (P < 0.001)。与奈韦拉平 (62%)、强化 PI (63%) 或单一 PI (53%) 方案相比，依非韦伦方案在一年内更有可能抑制 HIV-RNA (74%)（所有 P < 0.001），并且当根据基线临床特征和治疗分配倾向调整分析时，这种优越性得以维持。依非韦伦还产生了更有利的免疫学结果。结论：使用基于依非韦伦的方案开始首次联合 ART 的 HIV 感染者改善了病毒学和免疫学结果，并提高了依从性水平。 (c) 2007 年利平科特威廉姆斯和威尔金斯。
objectives: We aimed to determine adherence, virological, and immunological outcomes one year after starting a first combination antiretroviral therapy (ART) regimen.Design: Observational; synthesis of administrative, laboratory, and pharmacy data. Antiretroviral regimens were divided into efavirenz, nevirapine, boosted protease inhibitor (PI), and single PI categories. Propensity scores were used to control for confounding by treatment assignment. Adherence was estimated from pharmacy refill records.Setting: Veterans Affairs Healthcare System, all sites.Participants: HIV-infected individuals starting combination ART with a low likelihood of previous antiretroviral exposure.Interventions: None.Outcomes: The proportion of antiretroviral prescriptions filled as prescribed, a change in log HIV-RNA, the proportion with log HIV-RNA viral suppression, a change in CD4 cell count.Results: A total of 6394 individuals unlikely to have previous antiretroviral exposure started combination ART between 1996 and 2004, and were eligible for analysis. Adherence overall was low (63% of prescriptions filled as prescribed), and adherence with efavirenz (67%) and nevirapine (65%) regimens was significantly greater than adherence with boosted PI (59%) or single PI (61%) regimens (P < 0.001). Efavirenz regimens were more likely to suppress HIV-RNA at one year (74%) compared with nevirapine (62%), boosted PI (63%), or single PI (53%) regimens (all P < 0.001), and this superiority was maintained when analyses were adjusted for baseline clinical characteristics and propensity for treatment assignment. Efavirenz also yielded more favorable immunological outcomes.Conclusion: HIV-infected individuals initiating their first combination ART using an efavirenz-based regimen had improved virological and immunological outcomes and greater adherence levels. (c) 2007 Lippincott Williams & Wilkins.