Nellen Jeannine F J B, Nieuwkerk Pythia T, Burger David M, Wibaut Mirte, Gras Luuk A, Prins Jan M
Department of Internal Medicine, Division of Infectious Diseases, Tropical Medicine and AIDS, and Centre for Infection and Immunity Amsterdam, Academic Medical Centre, University of Amsterdam, Amsterdam, the Netherlands.
AIDS Care. 2009 Jul;21(7):842-50. doi: 10.1080/09540120802612816.
In industrialized countries, virological failure occurs more often among HIV-infected immigrant patients. Non-adherence is the most credible explanation. We compared adherence of immigrant patients with that of non-immigrant patients in the Netherlands, and investigated which method of adherence measurement is most suitable for daily use to predict virological treatment failure: testing knowledge of the current regimen, a quantitative adherence interview, pharmacy prescription refill ratio (dispensed medication divided by prescribed medication, DM/PM), and plasma drug levels. Included were 61 immigrants and 81 non-immigrants. Virological failure did occur more often in immigrants than in non-immigrants (19.7% (12/61) versus 8.6% (7/81), p=0.056), especially among previously naive patients (19.6% (11/56) versus 0% (0/54), p<0.01). There were no differences between both groups on any of the four adherence measures. Virological failure was associated with reporting stopping medication when not feeling well (OR=12, 95%CI=1.9-77.7, p=0.02), and, among naive patients, also with a DM/PM < 0.85 (Odds Ratio=5.1, 95%Confidence Interval=1.2-22.3, p=0.03). Although our study confirmed a much higher virological failure rate among immigrants, we were unable to identify clear differences in adherence between immigrants and non-immigrant patient, although virological failure was associated with stopping medication when not feeling well and a low DM/PM. Unstructured treatment interruptions are a likely explanation of the findings. Interventions should be aimed at preventing patients to stop medication. A DM/PM below 0.85 can be indicative for patients who did stop medication and are at risk for virological failure.
在工业化国家，HIV 感染的移民患者中病毒学失败更为常见。治疗依从性差是最可信的解释。我们比较了荷兰移民患者与非移民患者的依从性，并研究了哪种依从性测量方法最适合日常使用以预测病毒学治疗失败：测试对当前治疗方案的了解、定量依从性访谈、药房处方 refill 率（配药除以处方药，DM/PM）和血浆药物水平。纳入了 61 名移民和 81 名非移民。移民中的病毒学失败确实比非移民更常见（19.7%（12/61）对 8.6%（7/81），p = 0.056），尤其是在既往未接受过治疗的患者中（19.6%（11/56）对 0%（0/54），p < 0.01）。两组在四种依从性测量中的任何一项上均无差异。病毒学失败与报告感觉不适时停药有关（OR = 12，95%CI = 1.9 - 77.7，p = 0.02），并且在未接受过治疗的患者中，也与 DM/PM < 0.85 有关（优势比 = 5.1，95%置信区间 = 1.2 - 22.3，p = 0.03）。虽然我们的研究证实移民中的病毒学失败率要高得多，但我们无法确定移民和非移民患者在依从性方面的明显差异，尽管病毒学失败与感觉不适时停药和低 DM/PM 有关。非结构化治疗中断可能是这些结果的解释。干预措施应旨在防止患者停药。DM/PM 低于 0.85 可能表明患者已停药且有病毒学失败的风险。
