Haberer Jessica E, Musinguzi Nicholas, Boum Yap, Siedner Mark J, Mocello A Rain, Hunt Peter W, Martin Jeffrey N, Bangsberg David R
*Center for Global Health, Massachusetts General Hospital, Boston, MA; †Department of Medicine, Harvard Medical School, Boston, MA; ‡Global Health Collaboration, Mbarara University of Science and Technology, Mbarara, Uganda; §EpiCentre/Médecins Sans Frontières, Mbarara, Uganda; ‖Department of Medical Laboratory Sciences, Mbarara University of Science and Technology, Mbarara, Uganda; Departments of ¶Epidemiology and Biostatistics; #Medicine, University of California, San Francisco, CA; and **Department of Global Health and Populations, Harvard T.H. Chan School of Public Health, Boston, MA.
J Acquir Immune Defic Syndr. 2015 Dec 1;70(4):386-92. doi: 10.1097/QAI.0000000000000737.
Antiretroviral therapy (ART) adherence interruptions have been associated with viral rebound; however, the true risk is unknown because HIV RNA has never been measured during ongoing interruptions.
The Uganda AIDS Rural Treatment Outcomes Study is an observational longitudinal cohort of adults initiating ART. We monitored adherence with the device that wirelessly transmits records of device openings, and routinely assessed HIV RNA quarterly. When lapses of 48+ hours between device openings were detected, we made unannounced visits to participants to investigate the cause and assess HIV RNA. Generalized estimating equation logistic regressions were used to assess factors associated with viral rebound.
We followed 479 participants (median: 25 months per participant). Most were women (72%), median age was 36 years, median pre-ART CD4 count was 198 cells per microliter, median pre-ART HIV RNA level was 5.0 log10 copies per milliliter, and median duration of prior viral suppression was 13 months. A total of 587 adherence interruptions followed confirmed prior viral suppression, of which 13 (2%) had detectable viral rebound. Viral rebound was associated with duration of adherence interruption (odds ratio: 1.25 for each day beyond 48 hours; P = 0.007) and 30-day adherence before the interruption (odds ratio: 0.73; P = 0.02).
This article is the first demonstration of HIV RNA rebound during adherence interruptions objectively measured in real time. Odds of viral rebound increased by 25% with each day beyond 48 hours. Real-time adherence monitoring was feasible in a sub-Saharan African setting. Further research should assess the potential for real-time adherence interventions to sustain adherence to affordable first-line regimens.
抗逆转录病毒疗法（ART）依从性中断与病毒反弹有关；然而，由于在持续中断期间从未测量过HIV RNA，所以真正的风险尚不清楚。
乌干达艾滋病农村治疗结果研究是一项针对开始接受ART的成年人的观察性纵向队列研究。我们使用无线传输设备开启记录的装置监测依从性，并每季度定期评估HIV RNA。当检测到两次设备开启之间间隔48小时以上的漏服情况时，我们对参与者进行突击访视以调查原因并评估HIV RNA。采用广义估计方程逻辑回归来评估与病毒反弹相关的因素。
我们随访了479名参与者（中位数：每位参与者25个月）。大多数为女性（72%），年龄中位数为36岁，ART前CD4计数中位数为每微升198个细胞，ART前HIV RNA水平中位数为每毫升5.0 log10拷贝，既往病毒抑制的中位数持续时间为13个月。在先前已确认病毒抑制的情况下，共发生了587次依从性中断，其中13次（2%）出现了可检测到的病毒反弹。病毒反弹与依从性中断的持续时间相关（比值比：超过48小时的每一天为1.25；P = 0.007）以及中断前30天的依从性相关（比值比：0.73；P = 0.02）。
本文首次展示了在实时客观测量的依从性中断期间出现的HIV RNA反弹。超过48小时后，病毒反弹的几率每天增加25%。在撒哈拉以南非洲地区进行实时依从性监测是可行的。进一步的研究应评估实时依从性干预措施对维持对经济实惠的一线治疗方案的依从性的潜力。
