Vallabhaneni Snigdha, Chandy Sara, Heylen Elsa, Ekstrand Maria
Center for AIDS Prevention Studies, University of California, San Francisco, USA.
AIDS Care. 2012;24(6):687-94. doi: 10.1080/09540121.2011.630370. Epub 2011 Nov 22.
Understanding the prevalence and correlates of treatment interruptions (TIs) in resource-limited settings is important for improving adherence. HIV-infected adults on highly active antiretroviral therapy (HAART) in Bangalore, India, were enrolled into a prospective cohort study assessing HAART adherence. Participants underwent a structured interview assessing adherence, including occurrence of TI > 48 hours since HAART initiation, length of TI, and self-reported reasons for TI. Serum HIV viral load (VL) and CD4 was measured at 6-month intervals. Baseline data are presented in this article. For the 552 participants mean age was 37.8, 32% were female, 70% were married, 45% earned < $2/day. Eighty-four percent were on nevirapine-based antiretroviral therapy; median duration on HAART was 18 months (range: 1-175) and median CD4 count was 318 cells/µl (IQR: 195-460) at time of study enrollment. Twenty percent (n=110) reported at least one TI; of these, 33% (n=36) reported more than one TI. Median length of most recent TI was 10 days (range: 2-1095). TI was associated with a higher probability of having VL > 400 copies/ml (43% versus 12%; p<0.001). After controlling for time on HAART, TI was more likely among those who were unmarried (OR: 1.9; CI: 1.2-3.1), those treated in a private clinic setting (OR: 2.7; CI: 1.6-4.6 compared with public, and OR: 4.1; CI: 1.9-9.0 compared with public-private setting), and those on efavirenz-based therapy (OR: 2.0; CI: 1.1-3.6). The most common self-reported reason for TI was "side effects" (n=28; 25%), followed by cost of therapy (n=24; 22%). We discuss implications for both individual and structural level interventions to reduce TIs.
了解资源有限环境下治疗中断（TI）的患病率及其相关因素对于提高依从性很重要。印度班加罗尔接受高效抗逆转录病毒治疗（HAART）的HIV感染成年人被纳入一项评估HAART依从性的前瞻性队列研究。参与者接受了一次结构化访谈，评估依从性，包括自开始HAART以来TI>48小时的发生情况、TI的时长以及TI的自我报告原因。每6个月测量一次血清HIV病毒载量（VL）和CD4。本文展示了基线数据。552名参与者的平均年龄为37.8岁，32%为女性，70%已婚，45%日收入低于2美元。84%的人接受基于奈韦拉平的抗逆转录病毒治疗；HAART的中位疗程为18个月（范围：1 - 175个月），研究入组时CD4计数的中位数为318个细胞/微升（四分位距：195 - 460）。20%（n = 110）的人报告至少有一次TI；其中，33%（n = 36）的人报告有不止一次TI。最近一次TI的中位时长为10天（范围：2 - 1095天）。TI与VL>400拷贝/毫升的可能性更高相关（43%对12%；p<0.001）。在控制HAART疗程时间后，未婚者（比值比：1.9；可信区间：1.2 - 3.1）、在私立诊所接受治疗者（与公立诊所相比，比值比：2.7；可信区间：1.6 - 4.6，与公私合营诊所相比，比值比：4.1；可信区间：1.9 - 9.0）以及接受基于依非韦伦治疗者（比值比：2.0；可信区间：1.1 - 3.6）发生TI的可能性更大。自我报告的TI最常见原因是“副作用”（n = 28；25%），其次是治疗费用（n = 24；22%）。我们讨论了针对个体和结构层面干预措施以减少TI的影响。
