Approaches to Objectively Measure Antiretroviral Medication Adherence and Drive Adherence Interventions
Approaches to Objectively Measure Antiretroviral Medication Adherence and Drive Adherence Interventions
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DOI：
10.1007/s11904-020-00502-5
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发表时间：
2020-05-19
影响因子：
4.6
通讯作者：
Gandhi, Monica
中科院分区：
文献类型：
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作者：
Spinelli, Matthew A.;Haberer, Jessica E.;Gandhi, Monica
评估抗逆转录病毒依从性的传统方法，如自我报告、药片计数和药房补充数据，在确定抗逆转录病毒治疗（ART）或暴露前预防（PrEP）的实际服药情况时可能不准确。HIV病毒载量可以作为抗逆转录病毒治疗依从性的替代指标，但在依从性降低后可能会出现病毒学控制的丧失，而病毒载量与PrEP无关。最近的发现依从性的药理学测量、电子依从性监测仪和可摄入的电子药片都可以作为更客观的依从性指标，在预测结果方面超过自我报告。药理学指标可以确定最近的依从性或累积的依从性。最近的给药措施包括血浆或尿液中的抗逆转录病毒水平，以及替诺福韦-恩曲他滨为基础治疗的患者干血斑（DBS）中的三磷酸恩曲他滨。尿替诺福韦试验最近已发展成为床边依从性监测的护理点试验。累积依从性指标评估几周到几个月的依从性，包括外周血单个核细胞或DBS中替诺福韦二磷酸的测量，以及头发中的ART水平。电子依从监视器和可摄入的电子药丸可以分别跟踪药瓶开口或药物摄入。新的和客观的依从性监测方法可分别用于在PrEP或ART的预防效果或病毒学控制丧失之前检测不依从性。
Purpose of Review Traditional methods to assess antiretroviral adherence, such as self-report, pill counts, and pharmacy refill data, may be inaccurate in determining actual pill-taking to both antiretroviral therapy (ART) or pre-exposure prophylaxis (PrEP). HIV viral loads serve as surrogates of adherence on ART, but loss of virologic control may occur well after decreases in adherence and viral loads are not relevant to PrEP. Recent Findings Pharmacologic measures of adherence, electronic adherence monitors, and ingestible electronic pills all serve as more objective metrics of adherence, surpassing self-report in predicting outcomes. Pharmacologic metrics can identify either recent adherence or cumulative adherence. Recent dosing measures include antiretroviral levels in plasma or urine, as well as emtricitabine-triphosphate in dried blood spots (DBS) for those on tenofovir-emtricitabine-based therapy. A urine tenofovir test has recently been developed into a point-of-care test for bedside adherence monitoring. Cumulative adherence metrics assess adherence over weeks to months and include measurement of tenofovir-diphosphate in peripheral blood mononuclear cells or DBS, as well as ART levels in hair. Electronic adherence monitors and ingestible electronic pills can track pill bottle openings or medication ingestion, respectively. New and objective approaches in adherence monitoring can be used to detect nonadherence prior to loss of prevention efficacy or virologic control with PrEP or ART, respectively.