通过CASE指数评分工具评估的最佳抗逆转录病毒疗法依从性与塞内加尔达喀尔HIV感染成人的病毒学抑制相关。

Optimal antiretroviral therapy adherence as evaluated by CASE index score tool is associated with virological suppression in HIV-infected adults in Dakar, Senegal.

作者信息

Byabene A K, Fortes-Déguénonvo L, Niang K, Manga M N, Bulabula A N H, Nachega J B, Seydi M

机构信息

Departement de Medecine Interne, Université Evangelique en Afrique, Bukavu, Republiqe Democratique du Congo.

Clinique des Maladies Infectieuses, CHU de Fann, Universite Cheikh Anta Diop, Dakar, Senegal.

出版信息

Trop Med Int Health. 2017 Jun;22(6):776-782. doi: 10.1111/tmi.12882. Epub 2017 May 22.

DOI:10.1111/tmi.12882

PMID:28407436

Abstract

OBJECTIVE

To determine the prevalence and factors associated with optimal antiretroviral therapy (ART) adherence and virological failure (VLF) among HIV-infected adults enrolled in the national ART programme at the teaching hospital of Fann, Dakar, Senegal.

METHODS

Cross-sectional study from 1 September 2013 to 30 January 2014.

OUTCOMES

(1) optimal ART adherence by the Center for Adherence Support Evaluation (CASE) Index Score (>10) and (2) VLF (HIV RNA > 1000 copies/ml). Diagnostic accuracy of CASE Index Score assessed using sensitivity (Se), specificity (Sp), positive predictive value (PPV), negative predictive value (NPV) and corresponding 95% confidence intervals (CIs). Multivariate logistic regression analysis was performed to identify independent factors associated with optimal adherence and VLF.

RESULTS

Of 98 HIV-infected patients on ART, 68% were female. The median (IQR) age was 42 (20-50) years. A total of 57 of 98 (60%) were on ART more than 3 years, and majority (88%) were on NNRTI-based first-line ART regimen. A total of 79 of 98 (80%) patients reported optimal ART adherence, and only five of 84 (5.9%) had documented VLF. Patients with VLF were significantly more likely to have suboptimal ART adherence (17.7% vs. 2.9%; P = 0.02). CASE Index Score showed the best trade-off in Se (78.9%, 95% CI: 54.4-93.9%), Sp (20.0%, 95% CI: 11.1-31.7), PPV (22.4, 95% CI: 13.1-34.2%) and NPV (76.5%, 95% CI: 50.1-93.2), when used VLF threshold of HIV RNA >50 copies/ml. Factors independently associated with VLF were CASE Index Score <10 ([aOR] = 13.0, 95% CI: 1.1-147.9; P = 0.04) and being a boosted PI-based ART regimen ([aOR] = 27.0, 95% CI: 2.4-309.4; P = 0.008).

CONCLUSIONS

Optimal ART adherence is achievable in a high proportion of HIV-infected adults in this study population. CASE Index Score was independently associated with virological outcomes, supporting usefulness of this low-cost ART adherence monitoring tool in this setting.

摘要

目的

确定在塞内加尔达喀尔法恩教学医院参加国家抗逆转录病毒治疗（ART）项目的HIV感染成人中，最佳ART依从性和病毒学失败（VLF）的患病率及相关因素。

方法

2013年9月1日至2014年1月30日的横断面研究。

结果

（1）通过依从性支持评估中心（CASE）指数评分（>10）评估最佳ART依从性，（2）VLF（HIV RNA>1000拷贝/ml）。使用敏感性（Se）、特异性（Sp）、阳性预测值（PPV）、阴性预测值（NPV）及相应的95%置信区间（CI）评估CASE指数评分的诊断准确性。进行多变量逻辑回归分析以确定与最佳依从性和VLF相关的独立因素。

结果

98例接受ART的HIV感染患者中，68%为女性。年龄中位数（IQR）为42（20 - 50）岁。98例中有57例（60%）接受ART超过3年，大多数（88%）采用基于非核苷类逆转录酶抑制剂（NNRTI）的一线ART方案。98例患者中有79例（80%）报告最佳ART依从性，84例中只有5例（5.9%）有记录的VLF。发生VLF的患者ART依从性欠佳的可能性显著更高（17.7%对2.9%；P = 0.02）。当使用HIV RNA>50拷贝/ml的VLF阈值时，CASE指数评分在Se（78.9%，95%CI：54.4 - 93.9%）、Sp（20.0%，95%CI：11.1 - 31.7）、PPV（22.4，95%CI：13.1 - 34.2%）和NPV（76.5%，95%CI：50.1 - 93.2）方面表现出最佳权衡。与VLF独立相关的因素为CASE指数评分<10（[调整后比值比（aOR）]=13.0，95%CI：1.1 - 147.9；P = 0.04）以及采用基于蛋白酶抑制剂（PI）的强化ART方案（[aOR]=27.0，95%CI：2.4 - 309.4；P = 0.008）。