Codina Carlos, Martínez Mireia, Tuset Montserrat, del Cacho Elena, Martín María Teresa, Miró José M, Mallolas Josep, de Lazzari Elisa, García Felipe, Martínez Esteban, Gatell José M, Ribas Josep
Servicio de Farmacia. Hospital Clinic de Barcelona. Spain.
Enferm Infecc Microbiol Clin. 2002 Dec;20(10):484-90. doi: 10.1016/s0213-005x(02)72850-4.
Knowledge of the patient's adherence to antiretroviral treatment is extremely useful for monitoring HIV infection. Several methods have been proposed to calculate adherence, but they all have certain problems at application. The aim of this study was to compare three of the available methods for assessing medication adherence in order to determine their accuracy for this purpose.
Three methods for evaluating medication adherence were prospectively studied: 1. Remaining pill count (RPC), 2. Structured interview (SI), and 3. Pharmacy registry of drug refills (DR). The RPC was considered the gold standard and sensitivity and specificity of the other methods was calculated according to the RPC. The study included 100 consecutive patients and had a follow-up of one year.
We were able to assess all three methods in 69 cases. The percentages of patients taking 95% or more of the prescribed dose according to the three methods were 72.5% (RPC), 85.5% (SI) and 81.2% (DR). Taking the RPC as gold standard, there was 75.1% concordance with the DR and 75.1% with the SI method. The sensitivities of the DM and SI were 52.6 % and 42.1 %, respectively. After one year of follow-up, patients with > 90% adherence (RPC) had a 1.29-times higher probability of achieving good virological response (CI 95% 1.04-1.62, p 5 0.0138).
Although concordance among the methods was acceptable, the SI and DR overestimated adherence as compared to the RPC. Since there is currently no ideal method for determining treatment adherence, it is important to combine several methods to minimize errors and provide results that are as close to the true situation as possible.
了解患者对抗逆转录病毒治疗的依从性对于监测HIV感染极为有用。已经提出了几种计算依从性的方法，但它们在应用中都存在一定问题。本研究的目的是比较三种现有的评估药物依从性的方法，以确定它们在此方面的准确性。
前瞻性地研究了三种评估药物依从性的方法：1. 剩余药丸计数（RPC），2. 结构化访谈（SI），3. 药物 refill 的药房登记（DR）。将RPC视为金标准，并根据RPC计算其他方法的敏感性和特异性。该研究纳入了100例连续患者，并进行了一年的随访。
我们能够在69例中评估所有三种方法。根据三种方法，服用规定剂量95%或更多的患者百分比分别为72.5%（RPC）、85.5%（SI）和81.2%（DR）。以RPC为金标准，与DR的一致性为75.1%，与SI方法的一致性为75.1%。DM和SI的敏感性分别为52.6%和42.1%。随访一年后，依从性>90%（RPC）的患者实现良好病毒学反应的概率高1.29倍（95%CI 1.04 - 1.62，p = 0.0138）。
尽管方法之间的一致性可以接受，但与RPC相比，SI和DR高估了依从性。由于目前没有确定治疗依从性的理想方法，重要的是结合多种方法以尽量减少误差并提供尽可能接近真实情况的结果。
