Baseline CD4 Count and Adherence to Antiretroviral Therapy: A Systematic Review and Meta-Analysis
Baseline CD4 Count and Adherence to Antiretroviral Therapy: A Systematic Review and Meta-Analysis
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DOI：
10.1097/qai.0000000000001092
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发表时间：
2016-12-15
影响因子：
3.6
通讯作者：
Ford, Nathan
中科院分区：
文献类型：
--
作者：
Bock, Peter;James, Anelet;Ford, Nathan
背景：鉴于世界卫生组织最近对抗逆转录病毒治疗（ART）指南的修改以及对早期开始抗逆转录病毒治疗的依从性的持续关注，我们对已发表的文献进行了系统回顾，以回顾基线（开始抗逆转录病毒治疗前）CD4计数与全球参加抗逆转录病毒治疗计划的成年人抗逆转录病毒治疗依从性之间的关系。方法：系统检索Medline、Web of Science、LILACS、AIM、IMEMR和WPIMR数据库中2004年1月1日至2015年9月30日发表的英文原创研究。我们根据研究定义和使用随机效应模型汇总数据，计算CD4细胞计数较高与CD4细胞计数较低时的粘附几率。结果：28篇文章被纳入综述，18篇文章被纳入meta分析。CD4细胞计数较高组患者坚持治疗的几率略低（合并优势比为0.90；95%可信区间为0.84 ~ 0.96）；然而，大多数研究发现，当比较CD4计数水平时，依从性的几率没有差异。在CD4细胞计数高于和低于每微升500个细胞的比较分析中，依从性没有差异（合并优势比为1.01；95%置信区间为0.97至1.05）。结论：本综述无法找到与基线CD4计数相关的依从性差异的一致证据。尽管对于治疗所有艾滋病毒阳性个体而不考虑CD4细胞计数的新建议来说，这是令人鼓舞的，但仍需要进行额外的高质量研究，特别是在CD4细胞计数较高时开始抗逆转录病毒治疗的成年人中。
Background: In light of recent changes to antiretroviral treatment (ART) guidelines of the World Health Organization and ongoing concerns about adherence with earlier initiation of ART, we conducted a systematic review of published literature to review the association between baseline (pre-ART initiation) CD4 count and ART adherence among adults enrolled in ART programs worldwide.Methods: We performed a systematic search of English language original studies published between January 1, 2004 and September 30, 2015 using Medline, Web of Science, LILACS, AIM, IMEMR, and WPIMR databases. We calculated the odds of being adherent at higher CD4 count compared with lower CD4 count according to study definitions and pooled data using random effects models.Results: Twenty-eight articles were included in the review and 18 in the meta-analysis. The odds of being adherent was marginally lower for patients in the higher CD4 count group (pooled odds ratio, 0.90; 95% confidence interval, 0.84 to 0.96); however, the majority of studies found no difference in the odds of adherence when comparing CD4 count strata. In analyses restricted to comparisons above and below a CD4 count of 500 cells per microliter, there was no difference in adherence (pooled odds ratio, 1.01; 95% confidence interval: 0.97 to 1.05).Conclusions: This review was unable to find consistent evidence of differences in adherence according to baseline CD4 count. Although this is encouraging for the new recommendations to treat all HIV-positive individuals irrespective of CD4 count, there is a need for additional high-quality studies, particularly among adults initiating ART at higher CD4 cell counts.