Duarte Horacio A, Harris Donald Robert, Tassiopoulos Katherine, Leister Erin, Negrini Silvia Fabiana Biason de Moura, Ferreira Flávia Faleiro, Cruz Maria Letícia Santos, Pinto Jorge, Allison Susannah, Hazra Rohan
Department of Pediatrics, University of Washington School of Medicine, Seattle, WA, USA.
Westat, Rockville, MD, USA.
Braz J Infect Dis. 2015 May-Jun;19(3):263-71. doi: 10.1016/j.bjid.2015.01.004. Epub 2015 Mar 3.
Few studies have examined antiretroviral therapy adherence in Latin American children. Standardized behavioral measures were applied to a large cohort of human immunodeficiency virus-infected children in Brazil, Mexico, and Peru to assess adherence to prescribed antiretroviral therapy doses during the three days prior to study visits, assess timing of last missed dose, and evaluate the ability of the adherence measures to predict viral suppression. Time trends in adherence were modeled using a generalized estimating equations approach to account for possible correlations in outcomes measured repeatedly in the same participants. Associations of adherence with human immunodeficiency virus viral load were examined using linear regression. Mean enrollment age of the 380 participants was 5 years; 57.6% had undetectable' viral load (<400 copies/mL). At enrollment, 90.8% of participants were perfectly (100%) adherent, compared to 87.6% at the 6-month and 92.0% at the 12-month visit; the proportion with perfect adherence did not differ over time (p=0.1). Perfect adherence was associated with a higher probability of undetectable viral load at the 12-month visit (odds ratio=4.1, 95% confidence interval: 1.8-9.1; p<0.001), but not at enrollment or the 6-month visit (p>0.3). Last time missed any antiretroviral therapy dose was reported as "never" for 52.0% at enrollment, increasing to 60.7% and 65.9% at the 6- and 12-month visits, respectively (p<0.001 for test of trend). The proportion with undetectable viral load was higher among those who never missed a dose at enrollment and the 12-month visit (p≤0.005), but not at the 6-month visit (p=0.2). While antiretroviral therapy adherence measures utilized in this study showed some association with viral load for these Latin American children, they may not be adequate for reliably identifying non-adherence and consequently children at risk for viral resistance. Other strategies are needed to improve the evaluation of adherence in this population.
很少有研究调查拉丁美洲儿童的抗逆转录病毒疗法依从性。对巴西、墨西哥和秘鲁大量感染人类免疫缺陷病毒的儿童队列应用标准化行为测量方法，以评估在研究访视前三天对规定抗逆转录病毒疗法剂量的依从性，评估最后一次漏服剂量的时间，并评估依从性测量方法预测病毒抑制的能力。使用广义估计方程方法对依从性的时间趋势进行建模，以考虑在同一参与者中重复测量的结果之间可能存在的相关性。使用线性回归分析依从性与人类免疫缺陷病毒病毒载量之间的关联。380名参与者的平均入组年龄为5岁；57.6%的参与者病毒载量“不可检测”（<400拷贝/毫升）。入组时，90.8%的参与者完全（100%）依从，6个月访视时为87.6%，12个月访视时为92.0%；完全依从的比例随时间没有差异（p=0.1）。完全依从与12个月访视时病毒载量不可检测的较高概率相关（优势比=4.1，95%置信区间：1.8-9.1；p<0.001），但在入组或6个月访视时不相关（p>0.3）。入组时，52.0%的人报告最后一次漏服任何抗逆转录病毒疗法剂量的时间为“从未”，6个月和12个月访视时分别增至60.7%和65.9%（趋势检验p<0.001）。在入组和12个月访视时从未漏服剂量的参与者中，病毒载量不可检测的比例较高（p≤0.005），但在6个月访视时不高（p=0.2）。虽然本研究中使用的抗逆转录病毒疗法依从性测量方法显示与这些拉丁美洲儿童的病毒载量有一定关联，但它们可能不足以可靠地识别不依从情况，从而无法识别有病毒耐药风险的儿童。需要其他策略来改善对该人群依从性的评估。
