Gross Robert, Yip Benita, Lo Re Vincent, Wood Evan, Alexander Christopher S, Harrigan P Richard, Bangsberg David R, Montaner Julio S G, Hogg Robert S
Division of Infectious Diseases, Department of Medicine, Center for Clinical Epidemiology and Biostatistics, Center for Education and Research in Therapeutics, University of Pennsylvania, Philadelphia, PA 19104-6021, USA.
J Infect Dis. 2006 Oct 15;194(8):1108-14. doi: 10.1086/507680. Epub 2006 Sep 12.
High levels of antiretroviral therapy adherence are important for human immunodeficiency virus type 1 (HIV-1) suppression, yet the magnitude of adherence required to maintain it is less well characterized. Furthermore, methods to accommodate changes in adherence over time are lacking. In the present study, our objective was to determine the magnitude of antiretroviral therapy adherence needed to maintain HIV-1 suppression by use of a time-updated adherence measure that has the potential to be of use in a clinical setting.
We examined a population-based cohort of HIV-1-infected subjects > or =18 years of age, residing in British Columbia, Canada, who started receiving antiretroviral therapy between 1 August 1996 and 30 September 2003, who had at least 2 consecutive viral loads <500 copies/mL and who had prescriptions filled at least 3 times during a follow-up period ending 30 September 2004. Virological failure was defined as the second of 2 consecutive viral loads >1000 copies/mL. Cox proportional hazards model was used to determine the relationship between virological failure and refill-based, time-updated surrogate measure of adherence.
Among the 1634 participants > or =18 years of age who initiated triple combination therapy during the study, 606 virological failure events were identified. In multivariate analyses, subjects with < or =95% adherence were 1.66 (95% confidence interval, 1.38-2.01) times more likely to experience virological failure than those with >95% adherence.
The highest levels of antiretroviral therapy adherence are associated with higher rates of maintained virological suppression. This simple, dynamic surrogate measure of adherence overcomes the limitation of single-point-in-time calculations of adherence and may be useful in real time to determine whether an individual is exhibiting incomplete adherence.
高水平的抗逆转录病毒疗法依从性对于抑制1型人类免疫缺陷病毒（HIV-1）很重要，但维持病毒抑制所需的依从性程度尚未得到很好的界定。此外，缺乏适应依从性随时间变化的方法。在本研究中，我们的目的是通过使用一种有可能用于临床环境的随时间更新的依从性测量方法，来确定维持HIV-1抑制所需的抗逆转录病毒疗法依从性程度。
我们研究了一个以人群为基础的队列，这些HIV-1感染受试者年龄≥18岁，居住在加拿大不列颠哥伦比亚省，于1996年8月1日至2003年9月30日开始接受抗逆转录病毒疗法，至少有2次连续病毒载量<500拷贝/毫升，且在截至2004年9月30日的随访期间至少有3次处方配药。病毒学失败定义为连续2次病毒载量>1000拷贝/毫升中的第二次。使用Cox比例风险模型来确定病毒学失败与基于再次配药的、随时间更新的依从性替代测量之间的关系。
在研究期间开始三联联合疗法的1634名年龄≥18岁的参与者中，确定了606次病毒学失败事件。在多变量分析中，依从性≤95%的受试者发生病毒学失败的可能性是依从性>95%的受试者的1.66倍（95%置信区间，1.38 - 2.01）。
最高水平的抗逆转录病毒疗法依从性与更高的病毒学抑制维持率相关。这种简单、动态的依从性替代测量克服了依从性单点计算的局限性，可能在实时确定个体是否存在不完全依从方面有用。
