Access Campaign, Médecins Sans Frontières, Geneva, Switzerland.
J Acquir Immune Defic Syndr. 2013 Sep 1;64(1):74-8. doi: 10.1097/QAI.0b013e31829f05ac.
Viral load monitoring has been proposed as a tool to reinforce adherence, but outcomes have never been systematically assessed.
A meta-analysis was conducted to systematically analyze the research on viral load monitoring as a tool to reinforce adherence. Viremic resuppression is defined here as a decrease in viral load beneath a particular threshold following viral load levels that have been elevated despite antiretroviral treatment.
Six databases were searched for studies published up to November 2012, which reported the use of viral load monitoring as a tool to identify patients in need of adherence support. Three conference abstract sites were reviewed for studies reported in the last 2 years. Randomized and quasi-randomized trials and observational studies, were eligible. No language or geographical restrictions were applied.
Six retrospective and 2 prospective observational studies reported data from 8 countries: South Africa, the United States, Thailand, Mali, Burkina Faso, Swaziland, India, and France. Five studies reported on viremic resuppression, with a pooled estimate of 70.5% (95% confidence interval: 56.6% to 84.4%) resuppressed. The remaining 3 studies all reported declines in mean viral load. Delayed onset of routine viral load monitoring was associated with the emergence of drug resistance.
The clear trend of resuppression, following viral load testing and adherence support, demonstrates the utility of viral load as a tool to identify patients in need of enhanced adherence support.
病毒载量监测被提议作为一种加强依从性的工具，但尚未对其结果进行系统评估。
进行了一项荟萃分析，以系统地分析病毒载量监测作为加强依从性的工具的研究。本文将病毒载量反弹定义为：尽管接受了抗逆转录病毒治疗，但病毒载量升高后，病毒载量降至特定阈值以下。
对截至 2012 年 11 月发表的研究进行了 6 个数据库的检索，这些研究报告了使用病毒载量监测作为一种工具，以确定需要依从性支持的患者。还对过去 2 年报告的研究的 3 个会议摘要网站进行了审查。合格的研究包括随机和半随机临床试验和观察性研究。未对语言或地理范围进行限制。
6 项回顾性和 2 项前瞻性观察性研究报告了来自 8 个国家的数据：南非、美国、泰国、马里、布基纳法索、斯威士兰、印度和法国。5 项研究报告了病毒载量反弹情况，总体估计反弹率为 70.5%（95%置信区间：56.6%至 84.4%）。其余 3 项研究均报告了平均病毒载量下降。常规病毒载量监测的延迟启动与耐药性的出现有关。
病毒载量检测和依从性支持后出现反弹的明显趋势，证明了病毒载量作为一种工具识别需要增强依从性支持的患者的有效性。
