1 Department of Medicine/Infectious Disease, School of Medicine, Emory University , Atlanta, Georgia .
AIDS Patient Care STDS. 2013 Dec;27(12):657-68. doi: 10.1089/apc.2013.0263.
We sought to develop individual-level Early Warning Indicators (EWI) of virologic failure (VF) for clinicians to use during routine care complementing WHO population-level EWI. A case-control study was conducted at a Durban clinic. Patients after ≥ 5 months of first-line antiretroviral therapy (ART) were defined as cases if they had VF [HIV-1 viral load (VL)>1000 copies/mL] and controls (2:1) if they had VL ≤ 1000 copies/mL. Pharmacy refills and pill counts were used as adherence measures. Participants responded to a questionnaire including validated psychosocial and symptom scales. Data were also collected from the medical record. Multivariable logistic regression models of VF included factors associated with VF (p<0.05) in univariable analyses. We enrolled 158 cases and 300 controls. In the final multivariable model, male gender, not having an active religious faith, practicing unsafe sex, having a family member with HIV, not being pleased with the clinic experience, symptoms of depression, fatigue, or rash, low CD4 counts, family recommending HIV care, and using a TV/radio as ART reminders (compared to mobile phones) were associated with VF independent of adherence measures. In this setting, we identified several key individual-level EWI associated with VF including novel psychosocial factors independent of adherence measures.
我们试图为临床医生开发个体水平的病毒学失败（VF）预警指标（EWI），以在常规护理中补充世界卫生组织的人群水平 EWI。在德班的一家诊所进行了一项病例对照研究。如果患者在一线抗逆转录病毒治疗（ART）后≥5 个月出现 VF[HIV-1 病毒载量（VL）>1000 拷贝/mL]，则将其定义为病例；如果 VL≤1000 拷贝/mL，则将其定义为对照（2:1）。药物补充和药丸计数用作依从性测量。参与者回答了一份包括经过验证的心理社会和症状量表的问卷。还从病历中收集了数据。VF 的多变量逻辑回归模型包括单变量分析中与 VF 相关的因素（p<0.05）。我们招募了 158 例病例和 300 例对照。在最终的多变量模型中，男性、没有积极的宗教信仰、不安全的性行为、有 HIV 患者的家庭成员、对诊所体验不满意、抑郁、疲劳或皮疹症状、低 CD4 计数、家人建议进行 HIV 护理以及使用电视/收音机作为 ART 提醒（与手机相比）与 VF 相关，独立于依从性措施。在这种情况下，我们确定了几个与 VF 相关的关键个体水平 EWI，包括与依从性措施无关的新的心理社会因素。
