McCluskey Suzanne M, Boum Yap, Musinguzi Nicholas, Haberer Jessica E, Martin Jeffrey N, Hunt Peter W, Marconi Vincent C, Bangsberg David R, Siedner Mark J
*Department of Medicine, Massachusetts General Hospital, Boston, MA; †Epicentre Mbarara Research Centre, Mbarara, Uganda; ‡Mbarara University of Science and Technology, Mbarara, Uganda; §Harvard Medical School, Boston, MA; Departments of ‖Epidemiology and Biostatistics; ¶Medicine, University of California San Francisco School of Medicine, San Francisco, CA; #Division of Infectious Diseases, Emory University School of Medicine, Atlanta, GA; and **Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, GA.
J Acquir Immune Defic Syndr. 2017 Oct 1;76(2):183-187. doi: 10.1097/QAI.0000000000001479.
The World Health Organization defines HIV virologic failure as 2 consecutive viral loads >1000 copies/mL, measured 3-6 months apart, with interval adherence support. We sought to empirically evaluate these guidelines using data from an observational cohort.
The Uganda AIDS Rural Treatment Outcomes study observed adults with HIV in southwestern Uganda from the time of antiretroviral therapy (ART) initiation and monitored adherence with electronic pill bottles.
We included participants on ART with a detectable HIV RNA viral load and who remained on the same regimen until the subsequent measurement. We fit logistic regression models with viral resuppression as the outcome of interest and both initial viral load level and average adherence as predictors of interest.
We analyzed 139 events. Median ART duration was 0.92 years, and 100% were on a nonnucleoside reverse-transcriptase inhibitor-based regimen. Viral resuppression occurred in 88% of those with initial HIV RNA <1000 copies/mL and 42% if HIV RNA was >1000 copies/mL (P <0.001). Adherence after detectable viremia predicted viral resuppression for those with HIV RNA <1000 copies/mL (P = 0.011) but was not associated with resuppression for those with HIV RNA >1000 copies/mL (P = 0.894; interaction term P = 0.077).
Among patients on ART with detectable HIV RNA >1000 copies/mL who remain on the same regimen, only 42% resuppressed at next measurement, and there was no association between interval adherence and viral resuppression. These data support consideration of resistance testing to help guide management of virologic failure in resource-limited settings.
世界卫生组织将HIV病毒学失败定义为在间隔3至6个月且有间歇期依从性支持的情况下，连续两次病毒载量>1000拷贝/毫升。我们试图利用一项观察性队列研究的数据，对这些指南进行实证评估。
乌干达艾滋病农村治疗结果研究观察了乌干达西南部开始接受抗逆转录病毒治疗（ART）的成年HIV感染者，并使用电子药瓶监测依从性。
我们纳入了接受ART治疗且HIV RNA病毒载量可检测到、并在下次测量前一直使用相同治疗方案的参与者。我们构建了逻辑回归模型，将病毒载量再次抑制作为感兴趣的结果，将初始病毒载量水平和平均依从性作为感兴趣的预测因素。
我们分析了139个事件。ART的中位持续时间为0.92年，100%的参与者使用的是以非核苷类逆转录酶抑制剂为基础的治疗方案。初始HIV RNA<1000拷贝/毫升的参与者中，88%实现了病毒载量再次抑制；而HIV RNA>1000拷贝/毫升的参与者中，这一比例为42%（P<0.001）。对于HIV RNA<1000拷贝/毫升的参与者，可检测到病毒血症后的依从性可预测病毒载量再次抑制（P=0.011）；但对于HIV RNA>1000拷贝/毫升的参与者，依从性与再次抑制无关（P=0.894；交互项P=0.077）。
在接受ART治疗且HIV RNA>1000拷贝/毫升、并持续使用相同治疗方案的患者中，下次测量时只有42%实现了病毒载量再次抑制，且间歇期依从性与病毒载量再次抑制之间无关联。这些数据支持在资源有限的环境中考虑进行耐药性检测，以帮助指导病毒学失败的管理。
