Brigham and Women's Hospital, Boston, Massachusetts, United States of America.
PLoS One. 2012;7(2):e31591. doi: 10.1371/journal.pone.0031591. Epub 2012 Feb 24.
A lower daily pill burden may improve adherence to antiretroviral treatment (ART) and clinical outcomes in patients with human immunodeficiency virus (HIV). This study assessed differences in adherence using the number of pills taken per day, and evaluated how adherence correlated with hospitalization.
Commercially insured patients in the LifeLink database with an HIV diagnosis (International Classification of Diseases, 9th Revision, Clinical Modification code 042.xx) between 6/1/2006 and 12/31/2008 and receipt of a complete ART regimen were selected for inclusion. Patients were grouped according to their daily pill count and remained on ART for at least 60 days. Outcomes included adherence and rates of hospitalization. Adherence was measured as the proportion of days between the start and end of the regimen in which the patient maintained supply of all initiated ART components. Logistic regressions assessed the relationship between pills per day, adherence, and hospitalization, controlling for demographics, comorbidities, and ART-naïve (vs. experienced) status.
7,073 patients met the study inclusion criteria, and 33.4%, 5.8%, and 60.8% received an ART regimen comprising one, two, or three or more pills per day, respectively. Regression analysis showed patients receiving a single pill per day were significantly more likely to reach a 95% adherence threshold versus patients receiving three or more pills per day (odds ratio [OR] = 1.59; P<0.001). Regardless of the number of pills received per day, patients were over 40% less likely to have a hospitalization if they were adherent to therapy (OR = 0.57; P<0.001). Patients receiving a single pill per day were 24% less likely to have a hospitalization versus patients receiving three or more pills per day (OR = 0.76; P = 0.003).
ART consisting of a single pill per day was associated with significantly better adherence and lower risk of hospitalization in patients with HIV compared to patients receiving three or more pills per day.
每天服用的药物剂量较少可能会提高接受抗逆转录病毒治疗（ART）的患者的治疗依从性并改善其临床结局，而治疗依从性与人类免疫缺陷病毒（HIV）有关。本研究通过每天服用的药物数量来评估治疗依从性的差异，并评估治疗依从性与住院之间的相关性。
本研究选择了 2006 年 6 月 1 日至 2008 年 12 月 31 日期间在 LifeLink 数据库中诊断为 HIV（国际疾病分类，第 9 版临床修订版代码 042.xx）且接受完整 ART 治疗方案的商业保险患者。根据每天服用的药物剂量对患者进行分组，并至少有 60 天接受 ART 治疗。研究结局包括治疗依从性和住院率。治疗依从性通过从治疗方案开始到结束期间患者维持所有起始 ART 药物供应的天数比例来衡量。Logistic 回归分析评估了每天服用的药物剂量、治疗依从性和住院之间的关系，并控制了人口统计学、合并症和初次接受 ART（vs. 经验性）治疗的情况。
7073 名患者符合研究纳入标准，其中 33.4%、5.8%和 60.8%分别接受了每天服用一片、两片或三片或更多片药物的 ART 治疗方案。回归分析显示，与每天服用三片或更多片药物的患者相比，每天服用一片药物的患者达到 95%治疗依从性阈值的可能性显著更高（比值比 [OR] = 1.59；P<0.001）。无论每天服用的药物剂量如何，治疗依从性较好的患者住院的可能性都降低了 40%以上（OR = 0.57；P<0.001）。与每天服用三片或更多片药物的患者相比，每天服用一片药物的患者住院的可能性降低了 24%（OR = 0.76；P = 0.003）。
与每天服用三片或更多片药物的患者相比，每天服用一片药物的 HIV 患者的治疗依从性显著提高，且住院风险降低。
