Segeral Olivier, Madec Yoann, Ban Boroath, Ouk Vara, Hak Chan Roeurn, Le Tiec Clotilde, Nerrienet Eric, Goujard Cécile, Taburet Anne Marie, Delfraissy Jean Francois, Fontanet Arnaud
Service de Médecine Interne, Centre Hospitalier Universitaire de Bicêtre, AP-HP, 94270 Le Kremlin Bicêtre, France.
AIDS Res Treat. 2010;2010:142076. doi: 10.1155/2010/142076. Epub 2009 Dec 31.
Background. Adherence to antiviral therapy is important for HIV-infected people living in low- and middle-income countries, because of poor access to alternative regimens. Methods. We conducted a cross-sectional survey of adherence in Cambodian patients enrolled in the ESTHER program and treated with WHO first-line regimen for at least 6 months. The survey was based on a self-report questionnaire, drug assay, MCV measurement, visual analog scale, and viral load HIV RNA. Results. Two hundred fifty-nine patients treated for a median of 16 months participated in the survey. At inclusion in the program, 158 patients (61%) were ARV-naïve. The virological success rate was 71% overall and 81% in previously ARV-naive patients. Considered individually, the measures suggested perfect adherence in 71% to 93% of patients. In multivariate analysis adjusted for sex and therapeutic status before HAART initiation, only the biological markers were associated with virological efficacy. Self-funded treatment before entry to the program was highly predictive of virological failure. Conclusion. Adherence was excellent in these Cambodian patients. Biological markers were predictive of virological efficacy. MCV might thus serve as a simple alternative for assessing adherence and predicting virological efficacy among patients receiving AZT- or d4T-based regimens.
背景。由于难以获得替代治疗方案，坚持抗病毒治疗对生活在低收入和中等收入国家的艾滋病毒感染者很重要。方法。我们对参加ESTHER项目并接受世卫组织一线治疗方案至少6个月的柬埔寨患者进行了一项关于依从性的横断面调查。该调查基于一份自我报告问卷、药物检测、平均红细胞体积测量、视觉模拟量表和艾滋病毒RNA病毒载量。结果。259名接受治疗的患者参与了调查，中位治疗时间为16个月。纳入该项目时，158名患者（61%）既往未接受过抗逆转录病毒治疗（ARV）。总体病毒学成功率为71%，既往未接受过ARV治疗的患者中这一比例为81%。单独来看，各项测量指标显示71%至93%的患者依从性良好。在对HAART开始前的性别和治疗状态进行调整的多变量分析中，只有生物学标志物与病毒学疗效相关。入组项目前自费治疗是病毒学失败的高度预测因素。结论。这些柬埔寨患者的依从性良好。生物学标志物可预测病毒学疗效。因此，平均红细胞体积可能是评估接受基于齐多夫定（AZT）或司他夫定（d4T）方案治疗的患者依从性和预测病毒学疗效的一种简单替代方法。
