Adherence to protease inhibitors, HIV-1 viral load, and development of drug resistance in an indigent population
Adherence to protease inhibitors, HIV-1 viral load, and development of drug resistance in an indigent population
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DOI：
10.1097/00002030-200003100-00008
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发表时间：
2000-03-10
期刊：
影响因子：
3.8
通讯作者：
Moss, A
中科院分区：
文献类型：
--
作者：
Bangsberg, DR;Hecht, FM;Moss, A
目的：为了研究艾滋病毒感染的无家可归者和边缘居住的人对蛋白酶抑制剂（PI）therapeutic.Design and setting的依从性，病毒抑制和抗逆转录病毒药物耐药性之间的关系：在一个观察性前瞻性队列中对受试者进行横断面分析，该队列系统地从免费餐线，无家可归者收容所和低收入，单间入住（SRO）酒店抽样。34名HIV感染者，PI治疗的中位数为12个月。主要结果：通过定期未公布的药丸计数、电子药物监测和自我报告测量的依从性; HIV RNA病毒载量;和与耐药性相关的HIV-1基因型变化。通过自我报告、药丸计数和电子药物监测，中位依从性分别为89%、73%和67%。38%的人口有超过90%的药丸计数坚持。根据不同的测量方法，坚持解释了36-65%的并发HIV RNA水平的变化。这三种坚持措施密切相关。在20名接受新的逆转录酶抑制剂（RTI）治疗的基因型患者中，有3名患者发生了主要蛋白酶基因置换。在12例接受PI治疗但未发生新RTI的基因型患者中，6例发生了原发性蛋白酶基因置换（P < 0.03）。结论：相当一部分无家可归者和边缘居住者对PI治疗有良好的依从性。一个强有力的关系被发现之间的独立的方法来衡量坚持和并发病毒抑制。PI阻力更密切相关的失败，以改变RTI时，开始PI比坚持的水平。(C)2000年利平科特威廉姆斯&威尔金斯。
Objective: To examine the relationship between adherence, viral suppression and antiretroviral resistance in HIV-infected homeless and marginally housed people on protease inhibitor (PI) therapy.Design and setting: A cross-sectional analysis of subjects in an observational prospective cohort systematically sampled from free meal lines, homeless shelters and low-income, single-room occupancy (SRO) hotels.Participants: Thirty-four HIV-infected people with a median of 12 months of PI therapy.Main outcomes: Adherence measured by periodic unannounced pill counts, electronic medication monitoring, and self-report; HIV RNA viral load; and HIV-1 genotypic changes associated with drug resistance.Results: Median adherence was 89, 73, and 67% by self-report, pill count, and electronic medication monitor, respectively. Thirty-eight per cent of the population had over 90% adherence by pill count. Depending on the measure, adherence explained 36-65% of the variation in concurrent HIV RNA levels. The three adherence measures were closely related. Of 20 genotyped patients who received a new reverse transcriptase inhibitor (RTI) when starting a Pi, three had primary protease gene substitutions. Of 12 genotyped patients who received a PI without a new RTI, six had primary protease gene substitutions (P < 0.03).Conclusion: A substantial proportion of homeless and marginally housed individuals had good adherence to PI therapy. A strong relationship was found between independent methods of measuring adherence and concurrent viral suppression. PI resistance was more closely related to the failure to change RTI when starting a PI than to the level of adherence. (C) 2000 Lippincott Williams & Wilkins.