A simple, dynamic measure of antiretroviral therapy adherence predicts failure to maintain HIV-1 suppression
A simple, dynamic measure of antiretroviral therapy adherence predicts failure to maintain HIV-1 suppression
复制标题
DOI：
10.1086/507680
复制
发表时间：
2006-10-15
影响因子：
6.4
通讯作者：
Hogg, Robert S.
中科院分区：
文献类型：
--
作者：
Gross, Robert;Yip, Benita;Hogg, Robert S.
背景。高水平的抗逆转录病毒治疗依从性对于抑制人类免疫缺陷病毒1型（HIV-1）很重要，但维持这种治疗所需的依从性的程度尚不清楚。此外，缺乏适应依从性随时间变化的方法。在本研究中，我们的目的是通过使用一种时间更新的依从性测量方法来确定维持HIV-1抑制所需的抗逆转录病毒治疗依从性的大小，该方法有可能在临床环境中使用。我们研究了一个以人群为基础的hiv -1感染者队列，年龄bb0 = 18岁，居住在加拿大不列颠哥伦比亚省，在1996年8月1日至2003年9月30日期间开始接受抗逆转录病毒治疗，至少连续两次病毒载量< 500拷贝/mL，并在截至2004年9月30日的随访期间至少配药3次。病毒学失败定义为连续2次病毒载量达到1000拷贝/mL。使用Cox比例风险模型来确定病毒学失败与基于再填充的、时间更新的依从性替代测量之间的关系。在研究期间开始三联疗法的1634名18岁参与者中，确定了606例病毒学失败事件。在多变量分析中，受试者的依从性为95%。最高水平的抗逆转录病毒治疗依从性与较高的维持病毒学抑制率相关。这种简单、动态的替代依从性测量方法克服了单时间点依从性计算的局限性，可能有助于实时确定个体是否表现出不完全依从性。
Background. High levels of antiretroviral therapy adherence are important for human immunodeficiency virus type 1 (HIV-1) suppression, yet the magnitude of adherence required to maintain it is less well characterized. Furthermore, methods to accommodate changes in adherence over time are lacking. In the present study, our objective was to determine the magnitude of antiretroviral therapy adherence needed to maintain HIV-1 suppression by use of a time-updated adherence measure that has the potential to be of use in a clinical setting.Methods. We examined a population-based cohort of HIV-1-infected subjects >= 18 years of age, residing in British Columbia, Canada, who started receiving antiretroviral therapy between 1 August 1996 and 30 September 2003, who had at least 2 consecutive viral loads < 500 copies/mL and who had prescriptions filled at least 3 times during a follow-up period ending 30 September 2004. Virological failure was defined as the second of 2 consecutive viral loads > 1000 copies/mL. Cox proportional hazards model was used to determine the relationship between virological failure and refill-based, time-updated surrogate measure of adherence.Results. Among the 1634 participants >= 18 years of age who initiated triple combination therapy during the study, 606 virological failure events were identified. In multivariate analyses, subjects with 95% adherence.Conclusions. The highest levels of antiretroviral therapy adherence are associated with higher rates of maintained virological suppression. This simple, dynamic surrogate measure of adherence overcomes the limitation of single-point-in-time calculations of adherence and may be useful in real time to determine whether an individual is exhibiting incomplete adherence.