Fong Raymond, Cheng Allen C, Vujovic Olga, Hoy Jennifer F
Department of Infectious Diseases, The Alfred Hospital, Melbourne, Vic. 3004, Australia.
Sex Health. 2013 Nov;10(5):442-7. doi: 10.1071/SH13043.
Recent antiretroviral regimens are potent and better tolerated, resulting in a low prevalence of treatment failure. It is important to identify the drivers of virological failure, so that patients at risk can be identified early and prevention strategies implemented.
We performed a retrospective case-control study of HIV-positive patients on antiretroviral therapy and managed at The Alfred Hospital during 2010 to evaluate the predictors of virological failure. Controls were matched 3:1 to cases by gender, and by clinical review in the same week as the diagnosis of virological failure in the case. Predictors of virological failure were identified by multivariate conditional logistic regression.
Thirty-nine patients were identified with treatment failure. In the multivariate model, characteristics associated with virological failure were missed clinic appointments in 1 year before virological failure (odds ratio (OR)=13.1, 95% confidence interval (CI): 2.8-61.1), multiple previous combined antiretroviral therapy regimens (OR =4.2, 95% CI:1.2-15.3), current hepatitis C infection (OR=8.6, 95% CI: 1.9-38.7), older age at HIV diagnosis (OR=1.1, 95% CI: 1.0-1.2), younger age at time of virological failure (OR=0.9, 95% CI: 0.8 to 1.0), and CD4 cell count at virological failure (OR=0.7, 95% CI: 0.5 to 0.9).
Targeted and appropriate adherence support should be provided to treatment-experienced patients, particularly those who have missed clinical appointments and those with hepatitis C coinfection. Further elucidation of the barriers to clinic attendance may optimise linkage and retention in care.
近期的抗逆转录病毒治疗方案疗效显著且耐受性更佳，导致治疗失败的发生率较低。识别病毒学失败的驱动因素很重要，以便能够早期识别有风险的患者并实施预防策略。
我们对2010年在阿尔弗雷德医院接受抗逆转录病毒治疗的HIV阳性患者进行了一项回顾性病例对照研究，以评估病毒学失败的预测因素。对照组与病例按性别以3:1匹配，并在病例诊断病毒学失败的同一周通过临床检查进行匹配。通过多变量条件逻辑回归确定病毒学失败的预测因素。
确定了39例治疗失败的患者。在多变量模型中，与病毒学失败相关的特征包括病毒学失败前1年内错过门诊预约（比值比（OR）=13.1，95%置信区间（CI）：2.8 - 61.1）、既往多种联合抗逆转录病毒治疗方案（OR =4.2，95% CI：1.2 - 15.3）、当前丙型肝炎感染（OR=8.6，95% CI：1.9 - 38.7）、HIV诊断时年龄较大（OR=1.1，95% CI：1.0 - 1.2）、病毒学失败时年龄较小（OR=0.9，95% CI：0.8至1.0）以及病毒学失败时的CD4细胞计数（OR=0.7，95% CI：0.5至0.9）。
应向有治疗经验的患者，特别是那些错过门诊预约的患者和合并丙型肝炎感染的患者提供有针对性的适当依从性支持。进一步阐明影响就诊的障碍可能会优化护理的联系和保留率。
