Levels of Adherence Required for Virologic Suppression Among Newer Antiretroviral Medications
Levels of Adherence Required for Virologic Suppression Among Newer Antiretroviral Medications
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DOI：
10.1345/aph.1p587
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发表时间：
2011-03-01
影响因子：
2.9
通讯作者：
Sheth, Neha Umesh
中科院分区：
文献类型：
--
作者：
Kobin, Allison Beth;Sheth, Neha Umesh
目的：为了确定新的抗逆转录病毒（ARV）药物，包括地瑞那韦，依曲韦林，和raltegravir.DATA资源：PubMed，MEDLINE（1950年至2010年10月），和谷歌学术文献检索所需的艾滋病毒病毒抑制的依从性水平进行了使用以下关键词在多个组合：抗逆转录病毒，艾滋病，艾滋病，依从性，地瑞那韦，raltegravir和依曲韦林。检索文献的参考书目进行了审查，以确定额外的reference.Study选择和数据提取：所有的文章在英文中确定的数据源和评价。研究没有国家的药物或药物类别的名称被excluded.DATA综合：有不同程度的坚持需要维持病毒学抑制，这取决于所使用的抗逆转录病毒药物类别。未加强的蛋白酶抑制剂（PI）所需的依从性水平已被确定为大于95%，但最近的研究表明，对加强的PI的依从性大于80%可能就足够了。非核苷类逆转录酶抑制剂（NNRTI）可能需要比加强PI更低的依从率;然而，研究结果各不相同，NNRTI有可能在不依从的情况下产生耐药性。评估雷特格韦需要坚持的研究尚未performed.CONCLUSIONS：研究表明，不同的抗逆转录病毒药物类别之间需要坚持的水平。随着加强PI和强效药物的出现，自20世纪90年代以来，所需的依从性已经下降。虽然目前的数据是有用的，但由于坚持测量的方法，结果存在差异。考虑到患者的依从性障碍，了解患者需要什么样的依从性水平对于帮助确定最佳的抗逆转录病毒治疗方案是有价值的。这些知识也可以帮助确定哪些患者需要深入的依从性咨询。进一步研究一种可靠的方法来测量依从性是至关重要的，以确定新的抗逆转录病毒药物，包括地瑞那韦，依曲韦林和雷特格韦所需的依从性水平。
OBJECTIVE: To determine the adherence levels needed for HIV virologic suppression with newer antiretroviral (ARV) medications, including darunavir, etravirine, and raltegravir.DATA SOURCES: Literature searches of PubMed, MEDLINE (1950-October 2010), and Google Scholar were performed using the following key words in multiple combinations: antiretroviral, HIV, AIDS, adherence, darunavir, raltegravir, and etravirine. A review of the bibliographies of retrieved articles was performed to identify additional references.STUDY SELECTION AND DATA EXTRACTION: All articles in English were identified from the data sources and evaluated. Studies that did not state names of medications or drug classes studied were excluded.DATA SYNTHESIS: There are differing levels of adherence needed to maintain virologic suppression, depending on the ARV class used. The adherence level needed for unboosted protease inhibitors (Pis) has been established as greater than 95%, but recent studies have shown that greater than 80% adherence to boosted PIs may be sufficient. Nonnucleoside reverse transcriptase inhibitors (NNRTIs) could require lower adherence rates than boosted PIs; however, study results are varied and NNRTIs carry a potential for developing resistance with nonadherence. Studies assessing the adherence needed for raltegravir have yet to be performed.CONCLUSIONS: Studies have shown differing levels of adherence needed among ARV classes of medications. With the advent of boosted PIs and potent medications, the amount of adherence needed has dropped since the 1990s. Although the current data are useful, there are discrepancies in the results due to the methods of adherence measurement. Knowing what adherence levels are needed is valuable in helping to determine the optimal ARV regimen for patients, given their adherence barriers. This knowledge can also help determine which patients require in-depth adherence counseling. Further research with a reliable method of measuring adherence is essential to determine adherence levels needed for newer ARV medications, including darunavir, etravirine, and raltegravir.