Similar adherence rates favor different virologic outcomes for patients treated with nonnucleoside analogues or protease inhibitors
Similar adherence rates favor different virologic outcomes for patients treated with nonnucleoside analogues or protease inhibitors
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DOI：
10.1086/426595
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发表时间：
2005-01-01
影响因子：
11.8
通讯作者：
Suter, F
中科院分区：
文献类型：
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作者：
Maggiolo, F;Ravasio, L;Suter, F
背景。这项前瞻性研究验证了坚持对病毒学失败风险的影响。方法。在参加该研究时，共有 543 名患者接受稳定（持续时间大于或等于 6 个月）且有效（病毒载量，≥ 50 个人类免疫缺陷病毒 [HIV] RNA 拷贝/mL）高效抗逆转录病毒治疗 (HAART) 方案的患者完成了一份源自成人艾滋病临床试验组依从性随访问卷的自我报告问卷。在接下来的 6 个月中对患者进行了随访，以记录病毒学失败，病毒学失败的定义为连续 2 次病毒载量测量结果为 1500 HIV RNA 拷贝/mL。只有治疗类型和基线依从率与病毒学终点显着相关。在报告依从率低于或等于75%的患者中，病毒学失败率为17.4%；对于依从率为 76% - 85% 的患者，该比率下降至 12.2%；对于依从率为 86% - 95% 的患者，该比率下降至 4.3%；对于依从率 > 95% 的患者，该比率下降至 2.4%。根据接受的治疗方案类型调整分析后，接受基于蛋白酶抑制剂（PI）的HAART且依从率高达85%的患者的病毒学失败率为120%，而仅接受基于非核苷类逆转录酶抑制剂（NNRTI）的HAART且依从率小于或等于75%的患者的病毒学失败率为110%。对于依从率为 75% - 95% 的 NNRTI 治疗患者和 PI 治疗患者的比较，优势比为 0.157（95% 置信区间，0.029 - 0.852）。服用的药丸数量和每日剂量与报告的依从率相关。结论。接受 NNRTI 治疗的患者报告的依从率高于接受 PI 治疗的患者。服药数量和每日服用剂量对依从性有显着影响。低依从性是病毒学失败的一个主要决定因素；然而，不同的疗法具有不同的依从性临界值，这决定了风险的显着增加。
Background. This prospective study verified the effect of adherence on the risk of virologic failure.Methods. At enrollment in the study, a total of 543 patients who were following a steady ( duration, greater than or equal to 6 months) and effective ( viral load, ! 50 human immunodeficiency virus [ HIV] RNA copies/ mL) regimen of highly active antiretroviral therapy ( HAART) completed a self- reported questionnaire derived from the Adult AIDS Clinical Trials Group Adherence Follow- up Questionnaire. Patients were followed up for the subsequent 6 months to document virologic failure, which was defined as 2 consecutive viral load measurements of 1500 HIV RNA copies/ mL.Results. Only the type of treatment and the adherence rate at baseline were significantly associated with the virologic end point. Among patients who reported an adherence rate of less than or equal to 75%, the rate of virologic failure was 17.4%; this rate decreased to 12.2% for patients whose adherence rate was 76% - 85%, to 4.3% for patients whose adherence rate was 86% - 95%, and to 2.4% for patients whose adherence rate was >95%. When analysis was adjusted according to the type of regimen received, patients who were receiving protease inhibitor ( PI) - based HAART and who had an adherence rate of up to 85% had a virologic failure rate of 120%, whereas, only for patients who were receiving nonnucleoside reverse- transcriptase inhibitor ( NNRTI) - based HAART and who had an adherence rate of less than or equal to 75%, the virologic failure rate was 110%. For the comparison of NNRTI- treated patients and PI- treated patients with an adherence rate of 75% - 95%, the odds ratio was 0.157 ( 95% confidence interval, 0.029 - 0.852). The number of pills and daily doses received correlated with the reported adherence rate.Conclusions. Patients receiving NNRTIs report a higher rate of adherence than do patients receiving PIs. Adherence is significantly influenced by the number of pills and daily doses received. Low adherence is a major determinant of virologic failure; however, different therapies have different cutoff values for adherence that determine a significant increment of risk.