Nachega Jean B, Parienti Jean-Jacques, Uthman Olalekan A, Gross Robert, Dowdy David W, Sax Paul E, Gallant Joel E, Mugavero Michael J, Mills Edward J, Giordano Thomas P
Department of Epidemiology, Pittsburgh University Graduate School of Public Health, Pennsylvania.
Clin Infect Dis. 2014 May;58(9):1297-307. doi: 10.1093/cid/ciu046. Epub 2014 Jan 22.
Contemporary antiretroviral treatment regimens are simpler than in the past, with lower pill burden and once-daily dosing frequency common. We performed a meta-analysis of randomized controlled trials (RCTs) to investigate the impact of pill burden and once-daily vs twice-daily dosing on ART adherence and virological outcomes.
A literature search of 4 electronic databases through 31 March 2013 was used. RCTs comparing once-daily vs twice-daily ART regimens that also reported on adherence and virological suppression were included. Study design, study population characteristics, intervention, outcome measures, and study quality were extracted. Study quality was rated using the Cochrane risk-of-bias tool.
Nineteen studies met our inclusion criteria (N = 6312 adult patients). Higher pill burden was associated with both lower adherence rates (P = .004) and worse virological suppression (P < .0001) in both once-daily and twice-daily subgroups, although the association with adherence in the once-daily subgroup was not statistically significant. The average adherence was modestly higher in once-daily regimens than twice-daily regimens (weighted mean difference = 2.55%; 95% confidence interval [CI], 1.23 to 3.87; P = .0002). Patients on once-daily regimens did not achieve virological suppression more frequently than patients on twice-daily regimens (relative risk [RR] = 1.01; 95% CI, 0.99 to 1.03; P = .50). Both adherence and viral load suppression decreased over time, but adherence decreased less with once-daily dosing than with twice-daily dosing.
Lower pill burden was associated with both better adherence and virological suppression. Adherence, but not virological suppression, was slightly better with once- vs twice-daily regimens.
当代抗逆转录病毒治疗方案比过去更简单，药丸负担更低，每日一次给药频率很常见。我们进行了一项随机对照试验（RCT）的荟萃分析，以研究药丸负担以及每日一次与每日两次给药对艾滋病治疗依从性和病毒学结果的影响。
通过检索4个电子数据库，检索截至2013年3月31日的文献。纳入比较每日一次与每日两次抗逆转录病毒治疗方案且报告了依从性和病毒学抑制情况的随机对照试验。提取研究设计、研究人群特征、干预措施、结局指标和研究质量。使用Cochrane偏倚风险工具对研究质量进行评分。
19项研究符合我们的纳入标准（N = 6312名成年患者）。在每日一次和每日两次亚组中，较高的药丸负担均与较低的依从率（P = 0.004）和较差的病毒学抑制（P < 0.0001）相关，尽管在每日一次亚组中与依从性的关联无统计学意义。每日一次治疗方案的平均依从性略高于每日两次治疗方案（加权平均差 = 2.55%；95%置信区间[CI]，1.23至3.87；P = 0.0002）。每日一次治疗方案的患者病毒学抑制频率并不高于每日两次治疗方案的患者（相对风险[RR] = 1.01；95%CI，0.99至1.03；P = 0.50）。依从性和病毒载量抑制均随时间下降，但每日一次给药时依从性下降幅度小于每日两次给药。
较低的药丸负担与更好的依从性和病毒学抑制相关。每日一次与每日两次治疗方案相比，依从性略好，但病毒学抑制情况并非如此。
