Glass Tracy R, De Geest Sabina, Hirschel Bernard, Battegay Manuel, Furrer Hansjakob, Covassini Matthias, Vernazza Pietro L, Bernasconi Enos, Rickenboch Martin, Weber Rainer, Bucher Heiner C
Basel Institute for Clinical Epidemiology, University Hospital Basel, Basel, Switzerland.
Antivir Ther. 2008;13(1):77-85.
The aim of this study was to explore the predictive value of longitudinal self-reported adherence data on viral rebound.
Individuals in the Swiss HIV Cohort Study on combined antiretroviral therapy (cART) with RNA <50 copies/ml over the previous 3 months and who were interviewed about adherence at least once prior to 1 March 2007 were eligible. Adherence was defined in terms of missed doses of cART (0, 1, 2 or >2) in the previous 28 days. Viral rebound was defined as RNA >500 copies/ml. Cox regression models with time-independent and -dependent covariates were used to evaluate time to viral rebound.
A total of 2,664 individuals and 15,530 visits were included. Across all visits, missing doses were reported as follows: 1 dose 14.7%, 2 doses 5.1%, >2 doses 3.8% taking <95% of doses 4.5% and missing > or =2 consecutive doses 3.2%. In total, 308 (11.6%) patients experienced viral rebound. After controlling for confounding variables, self-reported non-adherence remained significantly associated with the rate of occurrence of viral rebound (compared with zero missed doses: 1 dose, hazard ratio [HR] 1.03, 95% confidence interval [CI] 0.72-1.48; 2 doses, HR 2.17, 95% CI 1.46-3.25; >2 doses, HR 3.66, 95% CI 2.50-5.34). Several variables significantly associated with an increased risk of viral rebound irrespective of adherence were identified: being on a protease inhibitor or triple nucleoside regimen (compared with a non-nucleoside reverse transcriptase inhibitor), >5 previous cART regimens, seeing a less-experienced physician, taking co-medication, and a shorter time virally suppressed.
A simple self-report adherence questionnaire repeatedly administered provides a sensitive measure of non-adherence that predicts viral rebound.
本研究旨在探讨纵向自我报告的依从性数据对病毒反弹的预测价值。
瑞士HIV队列研究中，过去3个月接受联合抗逆转录病毒疗法（cART）且RNA<50拷贝/毫升、在2007年3月1日前至少接受过一次依从性访谈的个体符合条件。依从性根据过去28天漏服cART的剂量（0、1、2或>2剂）来定义。病毒反弹定义为RNA>500拷贝/毫升。使用具有时间独立和时间依赖协变量的Cox回归模型评估病毒反弹时间。
共纳入2664名个体和15530次访视。在所有访视中，漏服剂量报告如下：1剂14.7%，2剂5.1%，>2剂3.8%，服用剂量<95% 4.5%，连续漏服≥2剂3.2%。共有308名（11.6%）患者出现病毒反弹。在控制混杂变量后，自我报告的不依从性仍与病毒反弹发生率显著相关（与零漏服剂量相比：1剂，风险比[HR] 1.03，95%置信区间[CI] 0.72 - 1.48；2剂，HR 2.17，95% CI 1.46 - 3.25；>2剂，HR 3.66，95% CI 2.50 - 5.34）。确定了几个与病毒反弹风险增加显著相关的变量，无论依从性如何：使用蛋白酶抑制剂或三联核苷方案（与非核苷类逆转录酶抑制剂相比），既往cART方案>5种，看诊经验较少的医生，服用联合药物，以及病毒抑制时间较短。
反复使用的简单自我报告依从性问卷可提供一种敏感的不依从性测量方法，预测病毒反弹。
