Chkhartishvili Nikoloz, Rukhadze Nino, Svanidze Mariam, Sharvadze Lali, Dehovitz Jack A, Tsertsvadze Tengiz, McNutt Louise-Anne, del Rio Carlos
Infectious Diseases, AIDS and Clinical Immunology Research Center, Tbilisi, Georgia;
Infectious Diseases, AIDS and Clinical Immunology Research Center, Tbilisi, Georgia.
J Int AIDS Soc. 2014 Apr 9;17(1):18885. doi: 10.7448/IAS.17.1.18885. eCollection 2014.
There is little information on adherence to antiretroviral therapy (ART) in the Eastern European region. This prospective study evaluated multiple measures of adherence and their association with viral suppression among HIV patients in Georgia.
A prospective cohort study enrolled 100 consecutive antiretroviral-naïve adult (age ≥ 18 years) patients, who were followed for three months. Adherence was assessed by medication refill and three self-report measures (an AIDS Clinical Trial Group [ACTG] tool for four-day adherence, a visual analogue scale [VAS] and a rating task for 30-day adherence). The VAS represented a line anchored by 0 and 100% corresponding to the percentage of prescribed doses taken. The rating task asked patients to rate their ability to take all medications as prescribed, with responses categorized into six levels of adherence: very poor (0%), poor (20%), fair (40%), good (60%), very good (80%) and excellent (100%). Patients with adherence of ≥ 95% by medication refill, ACTG and VAS, and ≥ 80% by rating task, were defined as adherent.
Of 100 patients enrolled, eight had missing data and were excluded from analysis. Among the remaining 92 patients, the median age was 39 years, and 70% were men. Major modes of HIV acquisition were injection drug use (IDU; 47.3%) and heterosexual contact (44.1%). The proportions of adherent patients were as follows: 68% by medication refill, 90% by ACTG questionnaire, 38% by VAS and 42% by rating task. On average, four months after commencing ART, 52 (56.5%) patients had a viral load <400 copies/ml and 26 (28.3%) patients had a viral load <50 copies/ml. Of 43 persons with a history of IDU, 22 (51.2%) reached a viral load of <400 copies/ml. In multivariate analysis, only refill adherence was a statistically significant predictor of viral suppression of <400 copies/ml: the risk ratio was 1.7 (95% CI: 1.1-2.8). Refill adherence, VAS and rating task were associated with viral suppression of <50 copies/ml. Non-IDUs were twice as likely to achieve viral load <50 copies/ml compared to IDUs. Refill adherence had the largest area under the receiver-operating characteristic curve for predicting viral suppression.
Medication refill adherence was the strongest predictor of viral suppression. IDUs can achieve optimal virologic outcomes, but may require additional adherence support.
东欧地区关于抗逆转录病毒疗法（ART）依从性的信息较少。这项前瞻性研究评估了格鲁吉亚艾滋病毒患者依从性的多种衡量指标及其与病毒抑制的关联。
一项前瞻性队列研究纳入了100名连续的初治成年（年龄≥18岁）患者，对其进行为期三个月的随访。通过药物 refill 和三种自我报告方法评估依从性（一种用于评估四天依从性的艾滋病临床试验组[ACTG]工具、视觉模拟量表[VAS]以及一项用于评估30天依从性的评分任务）。VAS 是一条两端分别标有0和100%的直线，分别对应所服用规定剂量的百分比。评分任务要求患者对按照处方服用所有药物的能力进行评分，回答分为六个依从性等级：极差（0%）、差（20%）、一般（40%）、良好（60%）、非常好（80%）和优秀（100%）。通过药物 refill、ACTG 和 VAS 评估依从性≥95%，且通过评分任务评估依从性≥80%的患者被定义为依从者。
在纳入的100名患者中，8名患者有缺失数据，被排除在分析之外。在其余92名患者中，中位年龄为39岁，70%为男性。艾滋病毒感染的主要途径是注射吸毒（IDU；47.3%）和异性接触（44.1%）。依从性患者的比例如下：通过药物 refill 评估为68%，通过 ACTG 问卷评估为90%，通过 VAS 评估为38%，通过评分任务评估为42%。开始 ART 治疗平均四个月后，52名（56.5%）患者的病毒载量<400拷贝/ml，26名（28.3%）患者的病毒载量<50拷贝/ml。在43名有注射吸毒史的患者中，22名（51.2%）的病毒载量达到<400拷贝/ml。在多变量分析中，只有 refill 依从性是病毒载量<400拷贝/ml 的病毒抑制的统计学显著预测因素：风险比为1.7（95%CI：1.1 - 2.8）。Refill 依从性、VAS 和评分任务与病毒载量<50拷贝/ml 的病毒抑制相关。与注射吸毒者相比，非注射吸毒者实现病毒载量<50拷贝/ml 的可能性是其两倍。Refill 依从性在预测病毒抑制的受试者操作特征曲线下面积最大。
药物 refill 依从性是病毒抑制的最强预测因素。注射吸毒者可以实现最佳的病毒学结果，但可能需要额外的依从性支持。
