Nieuwkerk Pythia T, Oort Frans J
Department of Medical Psychology, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands.
J Acquir Immune Defic Syndr. 2005 Apr 1;38(4):445-8. doi: 10.1097/01.qai.0000147522.34369.12.
Adherence to highly active antiretroviral therapy (HAART) for HIV-1 infection is essential for plasma HIV-1 RNA suppression. Self-report is the most frequently used measure of adherence to HAART, but its validity is controversial. Studies on the relation between self-reported adherence and virologic treatment response have shown inconsistent results. We investigated whether this variability between studies about the effect of self-reported adherence on virologic treatment response could be attributed to study design features.
We searched for studies reporting on adult nonpregnant patients prescribed antiretroviral therapy for chronic HIV-1 infection using a self-reported adherence measure and providing information about the relation between adherence and plasma HIV-1 RNA concentrations. Meta-analysis with random effects modeling was used to pool data and to investigate sources of heterogeneity.
Sixty-five studies fulfilled inclusion criteria, containing data from 15,351 patients. The pooled odds ratio (95% confidence interval) of detectable plasma viral load in nonadherent patients was 2.31 (1.99-2.68). There was significant heterogeneity among studies (P < 0.001). Not ascertaining confidentiality of responses, use of actual viral load measurements, an adherence threshold lower than 95%, higher percentages of patients on their initial antiretroviral regimen, and higher percentages of patients with a history of intravenous drug use within a study were associated with higher point estimates.
Overall, we observed that self-reported adherence measures can distinguish between clinically meaningful patterns of medication-taking behavior. Distinct study characteristics were significantly associated with the relation between adherence and virologic response. These characteristics should be taken into consideration when interpreting results from studies on self-reported adherence.
坚持高效抗逆转录病毒疗法（HAART）治疗HIV-1感染对于抑制血浆HIV-1 RNA至关重要。自我报告是最常用的HAART依从性测量方法，但其有效性存在争议。关于自我报告的依从性与病毒学治疗反应之间关系的研究结果并不一致。我们调查了关于自我报告的依从性对病毒学治疗反应影响的研究之间的这种变异性是否可归因于研究设计特征。
我们搜索了使用自我报告的依从性测量方法报告为慢性HIV-1感染开具抗逆转录病毒疗法的成年非妊娠患者的研究，并提供关于依从性与血浆HIV-1 RNA浓度之间关系的信息。采用随机效应模型进行荟萃分析以汇总数据并调查异质性来源。
65项研究符合纳入标准，包含来自15351名患者的数据。未坚持治疗的患者中可检测到血浆病毒载量的合并比值比（95%置信区间）为2.31（1.99 - 2.68）。研究之间存在显著异质性（P < 0.001）。未确定回答的保密性、使用实际病毒载量测量、低于95%的依从性阈值、研究中处于初始抗逆转录病毒治疗方案的患者比例较高以及有静脉吸毒史的患者比例较高与较高的点估计值相关。
总体而言,我们观察到自我报告的依从性测量方法可以区分临床上有意义的服药行为模式。不同的研究特征与依从性和病毒学反应之间的关系显著相关。在解释自我报告依从性研究的结果时应考虑这些特征。
