坚持暴露前预防对注射吸毒者感染艾滋病毒风险的影响。
The impact of adherence to preexposure prophylaxis on the risk of HIV infection among people who inject drugs.
作者信息
Martin Michael, Vanichseni Suphak, Suntharasamai Pravan, Sangkum Udomsak, Mock Philip A, Leethochawalit Manoj, Chiamwongpaet Sithisat, Curlin Marcel E, Na-Pompet Supawadee, Warapronmongkholkul Anchalee, Kittimunkong Somyot, Gvetadze Roman J, McNicholl Janet M, Paxton Lynn A, Choopanya Kachit
机构信息
aThailand MOPH - US CDC Collaboration, Nonthaburi, Thailand bCenters for Disease Control and Prevention, Atlanta, USA cBangkok Tenofovir Study Group dBangkok Metropolitan Administration, Bangkok eThailand Ministry of Public Health, Nonthaburi, Thailand.
出版信息
AIDS. 2015 Apr 24;29(7):819-24. doi: 10.1097/QAD.0000000000000613.
OBJECTIVE
To describe participant adherence to daily oral tenofovir in an HIV preexposure prophylaxis (PrEP) trial, examine factors associated with adherence, and assess the impact of adherence on the risk of HIV infection.
DESIGN
The Bangkok Tenofovir Study was a randomized, double-blind, placebo-controlled trial conducted among people who inject drugs, 2005-2012.
METHODS
Participants chose daily visits or monthly visits. Study nurses observed participants swallow study drug and both initialed a diary. We assessed adherence using the diary. We examined adherence by age group and sex and used logistic regression to evaluate demographics and risk behaviors as predictors of adherence and Cox regression to assess the impact of adherence on the risk of HIV infection.
RESULTS
A total of 2413 people enrolled and contributed 9665 person-years of follow-up (mean 4.0 years, maximum 6.9 years). The risk of HIV infection decreased as adherence improved, from 48.9% overall to 83.5% for those with at least 97.5% adherence. In multivariable analysis, men were less adherent than women (P = 0.006) and participants 20-29 years old (P < 0.001) and 30-39 years old (P = 0.01) were less adherent than older participants. Other factors associated with poor adherence included incarceration (P = 0.02) and injecting methamphetamine (P = 0.04).
CONCLUSION
In this HIV PrEP trial among people who inject drugs, improved adherence to daily tenofovir was associated with a lower risk of HIV infection. This is consistent with trials among MSM and HIV-discordant heterosexual couples and suggests that HIV PrEP can provide a high level of protection from HIV infection.
目的
在一项HIV暴露前预防（PrEP）试验中描述参与者对每日口服替诺福韦的依从性，研究与依从性相关的因素，并评估依从性对HIV感染风险的影响。
设计
曼谷替诺福韦研究是一项于2005年至2012年在注射吸毒者中进行的随机、双盲、安慰剂对照试验。
方法
参与者选择每日就诊或每月就诊。研究护士观察参与者吞服研究药物，双方在日记上签字。我们使用日记评估依从性。我们按年龄组和性别检查依从性，并使用逻辑回归评估人口统计学和风险行为作为依从性的预测因素，使用Cox回归评估依从性对HIV感染风险的影响。
结果
共有2413人入组，提供了9665人年的随访（平均4.0年，最长6.9年）。随着依从性的提高，HIV感染风险降低，总体风险从48.9%降至依从性至少为97.5%者的83.5%。在多变量分析中，男性的依从性低于女性（P = 0.006），20 - 29岁（P < 0.001）和30 - 39岁（P = 0.01）的参与者的依从性低于年龄较大的参与者。与依从性差相关的其他因素包括监禁（P = 0.02）和注射甲基苯丙胺（P = 0.04）。
结论
在这项针对注射吸毒者的HIV PrEP试验中，每日替诺福韦依从性的提高与较低的HIV感染风险相关。这与男男性行为者和HIV抗体不一致的异性恋伴侣中的试验结果一致，表明HIV PrEP可以提供高水平的HIV感染防护。
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