Massachusetts General Hospital Center for Global Health, Ragon Institute of MGH, MIT, and Harvard, Harvard Medical School, Boston, USA.
AIDS. 2010 Nov 27;24(18):2835-40. doi: 10.1097/QAD.0b013e328340a209.
Although, single-tablet regimen (STR) efavirenz, emtricibine, and tenofovir disoproxil fumarate (EFV/FTC/TDF) may be appealing in HIV-infected persons who are at high risk for nonadherence, the degree to which this simplified formulation affects adherence is not known. The virologic effectiveness of this STR in a potentially nonadherent population remains a concern, given the rapid selection of drug resistance seen with these drugs.
We performed a prospective observational study assessing adherence and virologic response to EFV/FTC/TDF STR among a cohort of homeless and marginally housed individuals. We compared adherence and viral suppression to historical controls followed in the same cohort.
Adherence was higher in EFV/FTC/TDF STR regimen compared to non-one-pill-once-daily therapy (P = 0.006) after controlling for multiple confounders. Viral suppression (HIV RNA <50 copies/ml) was greater in EFV/ FTC/TDF STR than non-one-pill-once-daily regimens (69.2 versus 46.5%; P = 0.02), but there was no difference in viral suppression after controlling for adherence.
Once-daily EFV/TNF/FTC STR appears to be a reasonable option for individuals with multiple barriers to adherence. Randomized clinical trials addressing various therapeutic strategies for this patient population are needed.
虽然，在那些依从性差风险高的 HIV 感染者中，使用含依非韦伦、恩曲他滨和替诺福韦艾拉酚胺的单片复方制剂（STR）可能很有吸引力，但目前尚不清楚这种简化配方会在多大程度上影响依从性。鉴于这些药物耐药性的快速选择，对于这种潜在依从性差的人群，这种 STR 的病毒学有效性仍然令人担忧。
我们进行了一项前瞻性观察性研究，评估了无家可归和边缘居住的个体队列中依非韦伦/恩曲他滨/替诺福韦艾拉酚胺 STR 的依从性和病毒学反应。我们将该队列中接受相同治疗的历史对照者的依从性和病毒抑制情况进行了比较。
在控制了多种混杂因素后，与非每日一次一片治疗相比，EFV/FTC/TDF STR 方案的依从性更高（P=0.006）。EFV/FTC/TDF STR 的病毒抑制（HIV RNA<50 拷贝/ml）高于非每日一次一片治疗方案（69.2%对 46.5%；P=0.02），但在控制了依从性后，病毒抑制没有差异。
每日一次的 EFV/TNF/FTC STR 似乎是依从性差的个体的合理选择。需要针对该患者群体的各种治疗策略进行随机临床试验。
