HIV-infected patients receiving lopinavir/ritonavir-based antiretroviral therapy achieve high rates of virologic suppression despite adherence rates less than 95%
HIV-infected patients receiving lopinavir/ritonavir-based antiretroviral therapy achieve high rates of virologic suppression despite adherence rates less than 95%
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DOI：
10.1097/qai.0b013e318050d8c2
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发表时间：
2007-05-01
影响因子：
3.6
通讯作者：
Zingman, Barry S.
中科院分区：
文献类型：
--
作者：
Shuter, Jonathan;Sarlo, Julie A.;Zingman, Barry S.
背景资料：观察到需要极高水平的药物依从性才能实现完全的病毒学抑制，这在很大程度上是基于对接受基于HIV蛋白酶抑制剂（PI）的治疗而未使用利托那韦加强治疗的有治疗经验的患者的研究。本研究的目的是定义需要达到病毒学抑制的患者接受加强PI为基础的高活性抗逆转录病毒疗法（HAART）与洛匹那韦/利托那韦。方法：艾滋病病毒感染的成年人接受的方案包含洛匹那韦/利托那韦招募到一个前瞻性的，观察性研究之间的关系，坚持洛匹那韦/利托那韦和病毒学结果。使用药物事件监测系统（MEMS; Aardex，联合城，CA）测量依从性。第24周检测HIV-1病毒载量（VL）。80%的患者患有艾滋病，97%的患者在入组前接受了洛匹那韦/利托那韦治疗，大多数患者有7年以上的HAART治疗经验。总体平均依从性为73%。80%和59%分别达到VL <400拷贝/mL和VL <75拷贝/mL。达到VL <75拷贝/mL的患者的平均依从性为75%。在所有依从性四分位数中均观察到高病毒学抑制率，包括最低四分位数（依从性范围：23.5%-53.3%）。结论：中度依从性可导致大多数服用托匹那韦/利托那韦的HAART患者出现病毒学抑制。
Background: The observation that extremely high levels of medication adherence are required to achieve complete virologic suppression is based largely on studies of treatment-experienced patients receiving HIV protease inhibitor (PI)-based therapy without ritonavir boosting. This study aims to define the level of adherence needed to achieve virologic suppression in patients receiving boosted PI-based highly active antiretroviral therapy (HAART) with lopinavir/ritonavir.Methods: HIV-infected adults receiving a regimen containing lopinavir/ritonavir were recruited into a prospective, observational study of the relation between adherence to lopinavir/ritonavir and virologic outcomes. Adherence was measured using the Medication Event Monitoring System (MEMS; Aardex, Union City, CA). HIV-1 viral load (VL) was measured at week 24.Results: The final study population contained 64 subjects. Eighty percent had AIDS, 97% received lopinavir/ritonavir before enrollment, and most had more than 7 years of HAART experience. Mean adherence overall was 73%. Eighty percent and 59% achieved a VL < 400 copies/mL and a VL < 75 copies/mL, respectively. Mean adherence was 75% in those achieving a VL < 75 copies/mL. High rates of virologic suppression were observed in all adherence quartiles, including the lowest quartile (range of adherence: 23.5%-53.3%).Conclusions: Moderate levels of adherence can lead to virologic suppression in most patients taking topinavir/ritonavir-based HAART.