Policy Analysis, Inc., Brookline, MA, USA.
Expert Opin Pharmacother. 2012 Oct;13(15):2111-8. doi: 10.1517/14656566.2012.719875. Epub 2012 Sep 13.
The objective of this study was to examine adherence and persistency in HIV patients initiating first-line combination antiretroviral therapy (cART) with a non-nucleoside reverse transcriptase inhibitor (NNRTI)-based regimen.
Using US health insurance records, the authors identified all persons aged ≥ 18 years with HIV, who began NNRTI-based cART between 1 January 2003 and 30 September 2009. They examined adherence using proportion of days covered (PDC), and non-persistency based on evidence of discontinuation, switching or augmentation. Differences in non-adherence (1 - PC) and non-persistency were compared over 12 months, between three treatment groups: i) efavirenz, emtricitabine and tenofovir as a fixed-dose combination ('EFV/FTC/TDF'); ii) EFV-based regimens other than EFV/TDF/FTC, with ≥ 2 NRTIs ('EFV + ≥ 2 NRTIs'); and iii) nevirapine-based regimens with ≥ 2 NRTIs (NVP + ≥ 2 NRTIs).
There were 1874 patients receiving EFV/FTC/TDF, 893 receiving EFV + ≥ 2 NRTIs and 207 receiving NVP + ≥ 2 NRTIs. Adherence was lower for both EFV + ≥ 2 NRTIs and NVP + ≥ 2 NRTIs than for EFV/FTC/TDF (rate ratio (RR) = 1.57 and 2.01, respectively; both p < 0.01), while non-persistency was higher (hazard ratio (HR) = 1.56, p < 0.01 and 1.70, p < 0.01, respectively).
Adherence and persistency may differ between NNRTI-based regimens; additional analyses are needed to understand the reasons for these differences.
本研究旨在研究接受以非核苷类逆转录酶抑制剂（NNRTI）为基础的方案进行一线联合抗逆转录病毒治疗（cART）的 HIV 患者的依从性和持久性。
作者使用美国健康保险记录，确定了所有年龄≥18 岁、于 2003 年 1 月 1 日至 2009 年 9 月 30 日期间开始接受 NNRTI 为基础的 cART 的 HIV 患者。作者通过覆盖率（PDC）来检查依从性，并根据停药、换药或增效的证据来判断非持久性。在 12 个月内，比较了三个治疗组之间的非依从性（1 - PDC）和非持久性差异：i）依非韦伦、恩曲他滨和替诺福韦作为固定剂量组合（EFV/FTC/TDF）；ii）EFV 以外的基于 EFV 的方案，与至少 2 种 NRTIs（EFV + ≥ 2 NRTIs）；iii）与至少 2 种 NRTIs 的奈韦拉平为基础的方案（NVP + ≥ 2 NRTIs）。
共有 1874 名患者接受 EFV/FTC/TDF、893 名患者接受 EFV + ≥ 2 NRTIs 和 207 名患者接受 NVP + ≥ 2 NRTIs。EFV + ≥ 2 NRTIs 和 NVP + ≥ 2 NRTIs 的依从性均低于 EFV/FTC/TDF（RR 分别为 1.57 和 2.01，均<0.01），而非持久性更高（HR 分别为 1.56、<0.01 和 1.70、<0.01）。
NNRTI 为基础的方案之间的依从性和持久性可能存在差异；需要进一步分析以了解这些差异的原因。
