Viciana Pompeyo, Rubio Rafael, Ribera Esteve, Knobel Hernando, Iribarren José A, Arribas José R, Pérez-Molina José A
Servicio de Enfermedades Infecciosas, Hospital Virgen del Rocío, Sevilla, Spain.
Enferm Infecc Microbiol Clin. 2008 Mar;26(3):127-34. doi: 10.1157/13116748.
INTRODUCTION: Adherence is essential for successful antiretroviral therapy (ART), but complex dosing schedules compromise the adherence to and efficacy of this treatment. Once-daily (QD) ART simplifies treatment by lowering the dosing frequency and pill burden. The aim of this study, performed when QD regimens were still limited, was to determine the degree of adherence and patient satisfaction of QD dosing versus twice-daily dosing (BID) of ART. METHODS: Non-interventional, multicenter, longitudinal study, including initial (I), simplification (S), and rescue (R) therapies. Medical visits were performed at baseline, and at 3 and 6 months. A validated, structured questionnaire was used to assess adherence, and a visual analogical scale applied by independent observers was used to assess satisfaction. RESULTS: From May to December 2002, 978 patients were recruited. Average pill burden was 5 in QD vs. 6.1 in BID regimens. Undetectable viral load was achieved at 6 months in 83.7% (I), 87.5% (S), and 57.4% (R) of patients, with no significant differences between QD and BID. Adherence and satisfaction with ART were both significantly better in QD vs. BID regimens: 61.4% vs. 53.2% (P < .05) and 54.4% vs. 41.2% (P < .05), respectively. Multivariate analysis revealed the following variables to account for 1) Adherence to ART (OR; 95% CI): treatment satisfaction (1.53, 1.30-1.80), family support (1.25, 0.98-1.61), years of HIV infection (0.97, 0.94-1.003) and intravenous drug use (0.83, 0.70-0.99); 2) Satisfaction with ART: simplification group (1.70, 1.22-2.34), QD therapy (1.33, 1.13-1.56), years of HIV infection (0.95, 0.93-0.98), and CDC stage C (0.85, 0.73-1.01); and 3) Undetectable viral load: naive group (5.08, 3.14-8.22) and adherence (1.57, 1.13-2.17). CONCLUSION: QD antiretroviral schedules appear to be as effective as BID regimens, with better adherence and treatment satisfaction. This may positively affect treatment efficacy at long-term.
引言：坚持服药对于抗逆转录病毒疗法（ART）的成功至关重要，但复杂的给药方案会影响这种治疗的依从性和疗效。每日一次（QD）的ART通过降低给药频率和药片负担简化了治疗。本研究在QD方案仍有限的情况下进行，旨在确定ART每日一次给药与每日两次给药（BID）相比的依从程度和患者满意度。 方法：非干预性、多中心纵向研究，包括初始（I）、简化（S）和挽救（R）治疗。在基线以及3个月和6个月时进行医学随访。使用经过验证的结构化问卷评估依从性，由独立观察者应用视觉模拟量表评估满意度。 结果：2002年5月至12月，招募了978名患者。QD方案的平均药片负担为5片，而BID方案为6.1片。6个月时，分别有83.7%（I）、87.5%（S）和57.4%（R）的患者病毒载量检测不到，QD和BID之间无显著差异。与BID方案相比，QD方案中ART的依从性和满意度均显著更高：分别为61.4%对53.2%（P<.05）和54.4%对41.2%（P<.05）。多变量分析显示以下变量可解释：1）对ART的依从性（OR；95%CI）：治疗满意度（1.53，1.30 - 1.80）、家庭支持（1.25，0.98 - 1.61）、HIV感染年限（0.97，0.94 - 1.003）和静脉吸毒（0.83，0.70 - 0.99）；2）对ART的满意度：简化组（1.70，1.22 - 2.34）、QD治疗（1.33，1.13 - 1.56）、HIV感染年限（0.95，0.93 - 0.98）和疾病控制中心C期（0.85，0.73 - 1.01）；3）病毒载量检测不到：初治组（5.08，3.14 - 8.22）和依从性（1.57，1.13 - 2.17）。 结论：每日一次的抗逆转录病毒给药方案似乎与每日两次给药方案一样有效，且依从性和治疗满意度更高。这可能对长期治疗效果产生积极影响。
AIDS Res Hum Retroviruses. 2010-8
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