Key Laboratory of AIDS Immunology of National Health and Family Planning Commission, Department of Laboratory Medicine, The First Affiliated Hospital, China Medical University, Shenyang, China.
Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, Hangzhou, China.
Sex Transm Infect. 2018 May;94(3):163-168. doi: 10.1136/sextrans-2017-053217. Epub 2017 Jul 29.
To estimate the medicine-taking compliance (MTC) level, explore its facilitators and barriers, and quantify the association between MTC level and pre-exposure prophylaxis (PrEP) protective efficacy in individuals at risk of acquiring HIV being administered oral PrEP.
Meta-analysis.
We searched PubMed, Cochrane and Embase databases for published randomized controlled trials (RCTs) pertaining to MTC of oral PrEP for HIV prevention up to 16 January 2017.
The pooled proportion of MTC and risk ratio (RR) of HIV incidences between intervention group and control group were estimated.
We identified 10 eligible studies with 24 193 participants. The overall pooled MTC for oral HIV PrEP was 59.9% (95% CI 43.1% to 74.6%). Subgroup analyses revealed that the MTC level of participants aged <30 years was lower than those equal or older than 30 years (34.9% vs 69.6%, p<0.001); those studies that enrolled only women as participants had lower MTC than those only recruiting either only men or both men and women (31.3% vs 71.7% and 31.3% vs 71.0%, all p<0.01). Additionally, the HIV infection risk increased as the MTC level declines, with the incidence RRs being 0.28 (95% CI 0.19 to 0.41), 0.42 (95% CI 0.29 to 0.62) and 0.75 (95% CI 0.45 to 1.25) in the good (≥80%), moderate (60%~80%) and poor (<60%) MTC subgroups, respectively (linear trend test p<0.01).
According to the pooled proportion, the MTC of oral HIV PrEP is almost moderate, and its proportion in women and younger participants was relatively low. The protective efficacy of oral PrEP for HIV prevention increased with MTC level. These findings indicated that it is necessary to identify measures to enhance MTC of oral PrEP in future clinical usage, especially in women and younger participants with high HIV infection risk.
评估接受暴露前预防（PrEP）者的用药依从性（MTC）水平，探讨其促进因素和阻碍因素，并定量分析 MTC 水平与 PrEP 保护效果之间的关系。
荟萃分析。
检索 PubMed、Cochrane 和 Embase 数据库，以获取截至 2017 年 1 月 16 日有关 MTC 与接受 PrEP 预防 HIV 感染的口服 PrEP 相关的已发表随机对照试验（RCT）。
采用合并比例和干预组与对照组 HIV 发生率的风险比（RR）进行评估。
纳入 10 项研究，共 24193 名参与者。总体而言，口服 HIV PrEP 的 MTC 为 59.9%（95%CI：43.1%74.6%）。亚组分析显示，年龄<30 岁的参与者 MTC 水平低于年龄≥30 岁的参与者（34.9%比 69.6%，p<0.001）；仅纳入女性的研究 MTC 水平低于仅纳入男性或男女均纳入的研究（31.3%比 71.7%和 31.3%比 71.0%，均 p<0.01）。此外，随着 MTC 水平下降，HIV 感染风险增加，在 MTC 水平良好（≥80%）、中等（60%80%）和较差（<60%）亚组中，RR 分别为 0.28（95%CI：0.190.41）、0.42（95%CI：0.290.62）和 0.75（95%CI：0.45~1.25）（线性趋势检验 p<0.01）。
根据汇总比例，口服 HIV PrEP 的 MTC 接近中等水平，女性和年轻参与者的比例相对较低。口服 PrEP 预防 HIV 的保护效果随 MTC 水平的提高而增加。这些发现表明，在未来的临床应用中，有必要确定提高口服 PrEP 用药依从性的措施，尤其是在感染风险较高的女性和年轻参与者中。
