Miller Loren G, Golin Carol E, Liu Honghu, Hays Ron D, Hua Jenna, Wenger Neil S, Kaplan Andrew H
Division of Infectious Diseases, Harbor-UCLA Medical Center, and Harbor-UCLA Research and Education Institute, and UCLA AIDS Institute Center for AIDS Research, University of California Los Angeles, Los Angeles, California, USA.
J Infect Dis. 2004 Apr 15;189(8):1487-96. doi: 10.1086/382895. Epub 2004 Mar 31.
Transient human immunodeficiency virus (HIV) viremia, a common phenomenon among patients taking antiretroviral therapy, is often attributed to lapses in adherence to the medication regimen. We investigated this relationship in a prospective observational cohort of 128 patients initiating a new regimen.
A case of transient viremia was defined as an HIV RNA level of 40-1000 copies/mL ("blip") sandwiched between 2 months of HIV RNA levels <40 copies/mL ("pre" and "post"). Adherence was most often measured with a composite adherence score (CAS), which is primarily based on electronically measured adherence. Case subjects' adherence and dose-timing was compared with (1) that of other patients (control subjects), who had undetectable virus loads for 3 consecutive months, and (2) that during periods of sustained undetectable virus loads among the case subjects themselves, if available.
Among the 28 case subjects, mean CAS-measured adherence did not decrease before transient viremia; adherence during the pre, blip, and post periods were 86%, 84%, and 80%, respectively. Control subjects had lower adherence levels during the corresponding 3 months (77%, 79%, and 75%, respectively; P = .046). Among the 19 patients able to serve as their own controls, CAS-measured adherence was higher during the period of transient viremia than during control periods (P = .01). Similar relationships were found when comparing only electronically measured adherence on a week-wise basis. There were no significant differences in dose-timing error between case subjects and control subjects.
We found no evidence that transient HIV viremia is associated with decreases in adherence or differences in dose-timing. Other etiologies for transient viremia should be evaluated.
短暂性人类免疫缺陷病毒（HIV）病毒血症是接受抗逆转录病毒治疗患者中的常见现象，通常归因于药物治疗方案依从性的下降。我们在一个由128名开始新治疗方案的患者组成的前瞻性观察队列中研究了这种关系。
短暂性病毒血症病例定义为HIV RNA水平在40 - 1000拷贝/毫升（“波动”），夹在HIV RNA水平<40拷贝/毫升的两个月之间（“之前”和“之后”）。依从性最常通过综合依从性评分（CAS）来衡量，该评分主要基于电子测量的依从性。将病例受试者的依从性和给药时间与（1）其他患者（对照受试者）进行比较，这些对照受试者连续3个月病毒载量不可检测，以及（2）病例受试者自身病毒载量持续不可检测期间（如有）的情况进行比较。
在28例病例受试者中，短暂性病毒血症前通过CAS测量的平均依从性并未下降；在之前、波动和之后期间的依从性分别为86%、84%和80%。对照受试者在相应的3个月期间依从性水平较低（分别为77%、79%和75%；P = 0.046）。在19名能够作为自身对照的患者中，通过CAS测量的依从性在短暂性病毒血症期间高于对照期（P = 0.01）。在仅按周比较电子测量的依从性时也发现了类似的关系。病例受试者和对照受试者之间在给药时间误差方面没有显著差异。
我们没有发现证据表明短暂性HIV病毒血症与依从性下降或给药时间差异有关。应评估短暂性病毒血症的其他病因。
