HIV Epidemiology & Biostatistics Group, Research Department of Infection & Population Health, UCL Medical School, London, UK.
HIV Med. 2010 Mar;11(3):216-24. doi: 10.1111/j.1468-1293.2009.00771.x. Epub 2009 Dec 3.
The aim of the study was to assess whether a simple, routinely available measure of antiretroviral therapy (ART) adherence predicts viral rebound at the next HIV viral load (VL) measurement in virally suppressed patients.
The analysis was performed on the Royal Free HIV Cohort, London, UK. Each 'drug coverage-viral load episode' (DCVL episode) was defined as a 6-month period immediately prior to a VL < or =50 HIV-1 RNA copies/mL (time-zero), during which the patient had been continuously on HAART, with all measured VLs < or =50 copies/mL. The next VL after time-zero was used to assess whether VL rebound (defined as >200 copies/mL) had occurred. Drug coverage, our measure of adherence, was calculated as the proportion of days in the 6-month period covered by a valid prescription for at least three antiretroviral drugs.
A total of 376 (2.4%) VL rebounds occurred in 15 660 DCVL episodes among 1632 patients. Drug coverage was 100% for 32% of episodes, 95-99% for 16% of episodes and < or =60% for 10% of episodes. The risk ratio of rebound associated with a 10% increase in drug coverage, adjusted for potential confounding variables, was 0.93 (95% confidence interval 0.88-0.98).
Antiretroviral drug coverage assessed at the time of VL measurement in patients with undetectable VL is potentially clinically useful for predicting VL rebound at the next VL measurement.
本研究旨在评估一种简单的、常规可用的抗逆转录病毒治疗（ART）依从性测量方法是否能预测病毒载量（VL）抑制患者下一次 VL 测量时病毒反弹。
本分析基于英国伦敦皇家自由 HIV 队列进行。每个“药物覆盖率-VL 发作”（DCVL 发作）定义为 VL<或=50 HIV-1 RNA 拷贝/mL（时间零）之前的 6 个月期间，在此期间患者持续接受高效抗逆转录病毒治疗（HAART），所有测量的 VL<或=50 拷贝/mL。时间零后下一次 VL 用于评估是否发生 VL 反弹（定义为>200 拷贝/mL）。药物覆盖率是依从性的衡量标准，计算方法为 6 个月期间至少有三种抗逆转录病毒药物的有效处方覆盖的天数比例。
在 1632 名患者的 15660 个 DCVL 发作中，共发生了 376 次（2.4%）VL 反弹。发作的药物覆盖率为 100%占 32%，95%-99%占 16%，<或=60%占 10%。药物覆盖率每增加 10%，与反弹相关的风险比为 0.93（95%置信区间 0.88-0.98），调整了潜在混杂变量后。
在 VL 不可检测的患者中，在测量 VL 时评估抗逆转录病毒药物覆盖率，对于预测下一次 VL 测量时的 VL 反弹具有潜在的临床意义。
