Simple Adherence Assessments to Predict Virologic Failure among HIV-Infected Adults with Discordant Immunologic and Clinical Responses to Antiretroviral Therapy
Simple Adherence Assessments to Predict Virologic Failure among HIV-Infected Adults with Discordant Immunologic and Clinical Responses to Antiretroviral Therapy
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DOI：
10.1089/aid.2008.0035
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发表时间：
2008-08-01
影响因子：
1.5
通讯作者：
Chi, Benjamin H.
中科院分区：
文献类型：
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作者：
Goldman, Jason D.;Cantrell, Ronald A.;Chi, Benjamin H.
我们在赞比亚卢萨卡快速扩大服务规模的背景下，评估了两种抗逆转录病毒治疗 (ART) 依从性测量指标（药物持有率 (MPR) 和患者自我报告）和可检测到的 HIV 病毒血症之间的关联。根据对 ART 的不一致的临床和免疫反应，对怀疑治疗失败的一部分患者的药物依从性和结果进行了评估。该分析共纳入 913 名患者，从 ART 开始到病毒载量 (VL) 测量的中位时间为 744 天（第一季度、第三季度：511、919 天）。总体而言，随访期间，531 名 (58%) 患者具有最佳依从性 (MPR >= 95%)，306 名 (34%) 患者依从性不佳 (MPR 80-94%)，76 名 (8%) 患者依从性较差（测试时 MPR = 400 拷贝/ml。与具有最佳依从性的个体相比，依从性欠佳的患者病毒学失败的风险增加 [调整后的相对风险] (ARR): 1.3; 95% 置信区间 (CI): 1.0, 1.6] 和依从性差的患者 (ARR: 1.7; 95% CI: 1.3, 2.4) 在抗逆转录病毒治疗过程中，676 名患者 (74%) 报告没有漏服剂量，而报告有任何漏服剂量的患者与报告完全依从性的患者的比例没有显着差异。 （26% vs. 26%，p = 0.97）。在疑似治疗失败的患者中，较低的 MPR 与较高的可检测病毒血症率相关。然而，MPR 的次优敏感性和特异性限制了其作为病毒学失败的唯一预测指标的用途。
We evaluated the association between two antiretroviral therapy (ART) adherence measurements-the medication possession ratio (MPR) and patient self-report-and detectable HIV viremia in the setting of rapid service scale-up in Lusaka, Zambia. Drug adherence and outcomes were assessed in a subset of patients suspected of treatment failure based on discordant clinical and immunologic responses to ART. A total of 913 patients were included in this analysis, with a median time of 744 days (Q1, Q3: 511, 919 days) from ART initiation to viral load (VL) measurement. On aggregate over the period of follow-up, 531 (58%) had optimal adherence (MPR >= 95%), 306 (34%) had suboptimal adherence (MPR 80-94%), and 76 (8%) had poor adherence (MPR = 400 copies/ml when tested. When compared to individuals with optimal adherence, there was increasing risk for virologic failure in those with suboptimal adherence [ adjusted relative risk (ARR): 1.3; 95% confidence interval (CI): 1.0, 1.6] and those with poor adherence (ARR: 1.7; 95% CI: 1.3, 2.4) based on MPR. During the antiretroviral treatment course, 676 patients (74%) reported no missed doses. The proportion of patients with virologic failure did not differ significantly among those reporting any missed dose from those reporting perfect adherence (26% vs. 26%, p = 0.97). Among patients with suspected treatment failure, a lower MPR was associated with higher rates of detectable viremia. However, the suboptimal sensitivity and specificity of MPR limit its utility as a sole predictor of virologic failure.