Department of Health Services, Policy & Practice, Alpert Medical School, Brown University, Providence, RI 02912, USA.
AIDS. 2012 Jul 17;26(11):1415-23. doi: 10.1097/QAD.0b013e328354bed6.
Adherence to antiretroviral therapies (ART) is the strongest predictor of viral suppression among individuals infected with HIV, however, limited data exists to understand the patterns of adherence that confer the greatest benefit across different ART regimens.
Longitudinal data pooled from 16 studies conducted between 1997 and 2009 across the United States.
Adherence was measured using Medication Event Monitoring System. Percentage of time with sufficient drug concentrations (covered time) and the length of the longest treatment interruption during the 28 days prior to plasma HIV-RNA measurements were calculated. Logistic regression with generalized estimating equations was used to estimate medication-specific adherence estimates on detectable HIV-RNA (>400 copies/ml).
One thousand and eighty-eight participants with 3795 HIV-RNA measures were studied. Both lower covered time and greater longest interruption showed dose-response relationships with the odds of detectable HIV-RNA; however, estimates did not vary by medication regimen. Compared with 93-100% coverage, periods of 0-25% covered time had a three-fold increased risk of detectable HIV-RNA [odds ratio (OR) = 3.22, 95% confidence interval (CI): 2.48-4.19]. Similarly, compared to longest interruptions of 0-48 h, longest interruptions of 21-28 days had a nearly four-fold increased risk of detectable HIV-RNA (OR = 3.65, 95% CI: 2.77, 4.81).
We found that adherence was consistently strongly associated with treatment response across ART regimens. Of the patterns of adherence, longer interruptions may have greater impact than covered time. Future research should investigate additional methods for examining adherence patterns, understanding the determinants of consecutive missed doses and the evaluation of interventions designed to address interruptions in treatment.
抗逆转录病毒疗法（ART）的依从性是感染 HIV 的个体病毒抑制的最强预测因素，然而，现有的数据有限，无法了解在不同的 ART 方案中哪种依从模式能带来最大的益处。
在美国，1997 年至 2009 年间进行的 16 项研究的纵向数据汇总。
使用药物事件监测系统测量依从性。计算在血浆 HIV-RNA 测量前 28 天内有足够药物浓度（覆盖时间）的时间百分比和最长治疗中断时间。使用广义估计方程的逻辑回归来估计可检测 HIV-RNA（>400 拷贝/ml）时药物特异性依从估计值。
研究了 1088 名参与者的 3795 项 HIV-RNA 测量值。较低的覆盖时间和较长的最长中断时间与可检测 HIV-RNA 的几率呈剂量反应关系；然而，估计值不因药物方案而异。与 93-100%的覆盖时间相比，覆盖时间为 0-25%的时间段检测到 HIV-RNA 的风险增加了三倍[比值比（OR）=3.22，95%置信区间（CI）：2.48-4.19]。同样，与最长中断时间为 0-48 小时相比，最长中断时间为 21-28 天的检测到 HIV-RNA 的风险增加了近四倍（OR=3.65，95%CI：2.77,4.81）。
我们发现，在所有的 ART 方案中，依从性与治疗反应始终密切相关。在依从模式中，较长的中断时间可能比覆盖时间具有更大的影响。未来的研究应探讨检查依从模式的其他方法，了解连续漏服剂量的决定因素，并评估旨在解决治疗中断的干预措施。
