High Medication Possession Ratios Associated With Greater Risk of Virologic Failure Among Youth Compared With Adults in a Nigerian Cohort.
High Medication Possession Ratios Associated With Greater Risk of Virologic Failure Among Youth Compared With Adults in a Nigerian Cohort.
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DOI：
10.1097/qai.0000000000001670
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发表时间：
2018-07-01
期刊：
影响因子：
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通讯作者：
Losina E
中科院分区：
文献类型：
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作者：
Ahonkhai AA;Banigbe B;Adeola J;Bassett IV;Idigbe I;Okonkwo P;Freedberg KA;Regan S;Losina E
药物拥有率（MPR）被广泛用作衡量抗逆转录病毒治疗（ART）依从性的指标。许多青少年和年轻人（AYA）经历ART依从性挑战。我们的目的是确定MPR和病毒学失败（VF）之间的关系是否在尼日利亚的AYA和老年人之间是一致的。我们对2009年1月至2012年12月期间在尼日利亚10所大学附属艾滋病毒诊所开始ART的AYA（15-25岁）和成人（>25岁）进行了一项回顾性研究。我们使用多变量广义线性模型来评估年龄、MPR（ART剂量分配）/（ART开始后的天数）与ART治疗第一年VF风险（HIV RNA > 1，000拷贝/mL）之间的关系。队列包括1，508名AYA和11，376名老年人。VF在AYA中比老年人更常见（30% vs. 24% p<0.01）。总体而言，74%的患者依从性最佳，16%次佳，9%依从性差（MPR > 94%，80- 94%和<80%）。与老年人相比，AYA仅参加了较少的药房访问（5 vs. 6，p<0.001）。MPR越高，VF发生率越低（80- 94%，aRR 0.57; >94% aRR 0.43，p<0.001 vs. MPR <80%）。在MPR显示依从性最佳的人群中，26%的AYA患有VF，其风险比依从性最佳的老年人高出20%（p<0.001）。在尼日利亚队列中，MPR总体较高，低MPR与VF风险之间存在强相关性。尽管如此，26%的AYA与高MPR仍然有VF。了解AYA中MPR和病毒抑制之间的差异是一个重要的优先事项。
Medication possession ratio (MPR) is widely used as a measure of adherence to antiretroviral therapy (ART). Many adolescents and young adults (AYA) experience ART adherence challenges. Our objective was to determine whether the relationship between MPR and virologic failure (VF) is consistent between AYA and older adults in Nigeria. We conducted a retrospective study of AYA (15–25 years) and adults (>25 years) who initiated ART between January 2009 and December 2012 at 10 university-affiliated HIV clinics in Nigeria. We used multivariate generalized linear models to assess the relationship between age, MPR (ART doses dispensed)/(days since ART initiation), and risk of VF (HIV RNA >1,000 copies/mL) in the first year on ART. The cohort included 1,508 AYA and 11,376 older adults. VF was more common in AYA than older adults (30% vs. 24% p<0.01). Overall, 74% of patients had optimal, 16% suboptimal, and 9% poor adherence (MPR >94%, 80–94%, and <80%). AYA attended fewer pharmacy-only visits than older adults (5 vs. 6, p<0.001). Higher MPR was associated with decreased rate of VF (80–94%, aRR 0.57; >94% aRR 0.43, p<0.001 vs. MPR <80%). Among those with optimal adherence by MPR, 26% of AYA had VF, a risk that was 20% higher than for older adults with optimal adherence (p<0.001). In this Nigerian cohort, MPRs were high overall, and there was a strong association between low MPR and risk of VF. Nonetheless, 26% of AYA with high MPRs still had VF. Understanding the discrepancy between MPR and viral suppression in AYA is an important priority.