Valenti W M
University of Rochester School of Medicine and Dentistry, Rochester, NY, USA.
AIDS Read. 2001 Feb;11(2):77-80.
Our experience with other chronic diseases, such as hypertension, diabetes, and asthma, has shown that adherence to treatment over time is about 50%. In HIV treatment, a significantly higher rate of adherence (i.e., 95% or greater) is required to achieve good outcomes. HAART is effective and cost-effective. Even with the high cost of antiretroviral drugs, the decrease in hospital utilization in addition to improved quality of life with HAART more than offsets the increased cost of drugs. This cost shifting from hospital utilization has been shown to result in a decrease of total monthly costs of care in many settings. In addition to decreased mortality and cost savings from decreased hospital utilization associated with HAART, the appropriate use of expensive antiretroviral drugs and the resultant reduction in antiretroviral resistance can save lives and money over the long term. However, we know that the performance of drugs in clinical trials is not always borne out in today's real world of ambulatory HIV care, underscoring the need for treatment adherence strategies in the HAART era. Our understanding of what improves adherence to antiretroviral treatment is still incomplete. However, there are a number of approaches that address the patient, the provider/multidisciplinary team, and the treatment regimen itself. The dedicated TAC, while not the only solution, has been shown to be an effective team member and a solution worth considering in managed care settings. When added to the costs of today's care, this team member should still prove cost-effective in the final analysis.
我们在其他慢性病（如高血压、糖尿病和哮喘）方面的经验表明，长期坚持治疗的比例约为50%。在艾滋病治疗中，为了取得良好效果，需要显著更高的坚持治疗率（即95%或更高）。高效抗逆转录病毒治疗（HAART）是有效的且具有成本效益。即使抗逆转录病毒药物成本高昂，但HAART除了能提高生活质量外，还能减少住院率，这足以抵消药物成本的增加。在许多情况下，这种从住院率转移而来的成本已被证明能降低每月的总护理成本。除了降低死亡率以及因HAART减少住院率而节省成本外，合理使用昂贵的抗逆转录病毒药物以及由此减少的抗逆转录病毒耐药性从长远来看可以挽救生命并节省资金。然而，我们知道药物在临床试验中的表现并不总是能在当今艾滋病门诊护理的现实世界中得到验证，这突出了在HAART时代制定治疗坚持策略的必要性。我们对提高抗逆转录病毒治疗坚持率的因素的理解仍然不完整。然而，有许多方法可以从患者、提供者/多学科团队以及治疗方案本身入手。专门的治疗倡导中心（TAC）虽然不是唯一的解决方案，但已被证明是一个有效的团队成员，也是管理式医疗环境中值得考虑的一种解决方案。在当今护理成本的基础上再加上这一团队成员的成本，最终分析表明其仍应具有成本效益。
