Bangsberg D R, Hecht F M, Charlebois E D, Zolopa A R, Holodniy M, Sheiner L, Bamberger J D, Chesney M A, Moss A
Epidemiology and Prevention Interventions Center, Division of Infectious Diseases, San Francisco General Hospital, University of California San Francisco, 94110, USA.
AIDS. 2000 Mar 10;14(4):357-66. doi: 10.1097/00002030-200003100-00008.
To examine the relationship between adherence, viral suppression and antiretroviral resistance in HIV-infected homeless and marginally housed people on protease inhibitor (PI) therapy.
A cross-sectional analysis of subjects in an observational prospective cohort systematically sampled from free meal lines, homeless shelters and low-income, single-room occupancy (SRO) hotels.
Thirty-four HIV-infected people with a median of 12 months of PI therapy.
Adherence measured by periodic unannounced pill counts, electronic medication monitoring, and self-report; HIV RNA viral load; and HIV-1 genotypic changes associated with drug resistance.
Median adherence was 89, 73, and 67% by self-report, pill count, and electronic medication monitor, respectively. Thirty-eight per cent of the population had over 90% adherence by pill count. Depending on the measure, adherence explained 36-65% of the variation in concurrent HIV RNA levels. The three adherence measures were closely related. Of 20 genotyped patients who received a new reverse transcriptase inhibitor (RTI) when starting a PI, three had primary protease gene substitutions. Of 12 genotyped patients who received a PI without a new RTI, six had primary protease gene substitutions (P < 0.03).
A substantial proportion of homeless and marginally housed individuals had good adherence to PI therapy. A strong relationship was found between independent methods of measuring adherence and concurrent viral suppression. PI resistance was more closely related to the failure to change RTI when starting a PI than to the level of adherence.
研究接受蛋白酶抑制剂（PI）治疗的HIV感染无家可归者和居住条件差的人在服药依从性、病毒抑制和抗逆转录病毒耐药性之间的关系。
对从免费餐线、无家可归者收容所和低收入单人房间酒店系统抽样的观察性前瞻性队列中的受试者进行横断面分析。
34名接受PI治疗中位数为12个月的HIV感染者。
通过定期不通知的药丸计数、电子药物监测和自我报告来衡量依从性；HIV RNA病毒载量；以及与耐药性相关的HIV-1基因型变化。
通过自我报告、药丸计数和电子药物监测测得的依从性中位数分别为89%、73%和67%。38%的人群通过药丸计数显示依从性超过90%。根据测量方法的不同，依从性解释了同期HIV RNA水平变化的36%-65%。三种依从性测量方法密切相关。在开始使用PI时接受新的逆转录酶抑制剂（RTI）的20名进行基因分型的患者中，有3人发生了蛋白酶基因原发性置换。在未接受新RTI而仅接受PI的12名进行基因分型的患者中，有6人发生了蛋白酶基因原发性置换（P<0.03）。
相当一部分无家可归者和居住条件差的人对PI治疗有良好的依从性。在测量依从性的独立方法与同期病毒抑制之间发现了密切关系。PI耐药性与开始使用PI时未更换RTI的关系比与依从性水平的关系更为密切。
