Defining the optimal cut-point of self-reported ART adherence to achieve viral suppression in the era of contemporary HIV therapy: a cross-sectional study.
Defining the optimal cut-point of self-reported ART adherence to achieve viral suppression in the era of contemporary HIV therapy: a cross-sectional study.
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DOI：
10.1186/s12981-021-00358-8
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发表时间：
2021-06-26
影响因子：
2.2
通讯作者：
Cook RL
中科院分区：
文献类型：
--
作者：
O'Halloran Leach E;Lu H;Caballero J;Thomas JE;Spencer EC;Cook RL
当考虑坚持艾滋病毒的抗逆转录病毒疗法(ART)时，使用了许多不同的切入点。这项研究的主要目标是确定自我报告的服药依从性水平，以最好地区分艾滋病毒抑制和非抑制，并比较单项和三项依从性问卷预测艾滋病毒抑制的能力。这项横断面分析包括来自佛罗里达队列研究的380名艾滋病毒(PWH)患者，他们在接受艾滋病毒病毒负载测试后30天内完成了自我报告的ART依从性测量。我们使用受试者工作特征(ROC)曲线分析和ROC对比来比较单项和3项自我报告依从性测量预测艾滋病毒抑制(定义为≤200拷贝/毫升)的能力。我们使用Youden指数和卡方统计来评估特定的切点，并使用不同的艾滋病毒病毒抑制定义(≤1000拷贝/毫升)重复分析。使用单项评分的平均坚持百分比为92.4%，使用三项评分的平均坚持百分比为90.4%；81.6%的患者有病毒抑制。单项和3项遵守措施的曲线下面积总体上很差，彼此之间没有显著差异(0.589和0.580，p=0.67)。Youden指数确定的分界点为93%和89%，分别为单项和3项指标的最高灵敏度和特异度，而单项指标80%的分界点最能区分病毒抑制的患者(58%对84%，p<；0.001)。结果与定义为≤1000拷贝/毫升的病毒抑制相似。在PWH的这个样本中，一个关于服药依从性的问题在预测HIV病毒抑制方面与三项问卷一样好，尽管两者都没有很好的区分能力。接近90%依从性的临界点最大限度地提高了敏感性和特异度，尽管几乎所有超过80%的指标对病毒的抑制都非常相似。
When considering adherence to antiretroviral therapy (ART) for HIV, many different cut-points are used. The primary goals of this study were to identify a level of self-reported medication adherence that best distinguished HIV viral suppression from non-suppression, and to compare the ability of a single-item and a 3-item adherence questionnaire to predict HIV viral suppression. This cross-sectional analysis included 380 persons with HIV (PWH) from the Florida Cohort study who completed a self-reported ART adherence measure within 30-days of having an HIV viral load test. We used Receiver Operating Characteristic (ROC) curve analyses and ROCContrast to compare the ability of a single-item and a 3-item self-reported adherence measure to predict HIV viral suppression (defined as ≤ 200 copies/mL). We used the Youden index and chi square statistics to assess specific cut-points, and repeated the analysis with a different definition of HIV viral suppression (≤ 1000 copies/mL). The mean percent adherence was 92.4% using the single-item score and 90.4% using the 3-item score; 81.6% had viral suppression. The areas under the curve for the single-item and 3-item adherence measures were generally poor overall and not significantly different from each other (0.589 and 0.580, p = 0.67). The Youden index identified cut-points of 93% and 89% as maximizing the sensitivity and specificity for the single-item and 3-item measures, respectively, whereas a cut-point of 80% on the single-item measure was best able to discriminate those with viral suppression (58% vs. 84%, p < 0.001). Results were similar with viral suppression defined as ≤ 1000 copies/mL. In this sample of PWH, a single question on medication adherence was as good as a 3-item questionnaire in predicting HIV viral suppression, although neither had good discriminatory ability. A cut-point close to 90% adherence maximized sensitivity and specificity, although viral suppression was very similar for nearly all measures above 80%.
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影响因子：
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