Nnambalirwa Maria, Govathson Caroline, Evans Denise, McNamara Lynne, Maskew Mhairi, Nyasulu Peter
School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa.
Health Economics and Epidemiology Research Office, Department of Internal Medicine, School of Clinical Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa.
Trans R Soc Trop Med Hyg. 2016 Dec 1;110(12):696-704. doi: 10.1093/trstmh/trx003.
To date, there is no consensus on ideal ways to measure antiretroviral treatment (ART) adherence in resource limited settings. This study aimed to identify markers of poor adherence to ART.
Retrospective data of HIV-positive ART-naïve adults initiating standard first-line ART at Themba Lethu Clinic, Helen Joseph Hospital, Johannesburg, South Africa from April 2004 to December 2011 were analysed. Poisson regression models with robust error variance were used to assessed the following potential markers of poor adherence 'last self-reported adherence, missed clinic visits, mean corpuscular volume (MCV), CD4 count against definition of adherence, suppressed HIV viral load using traditional test metrics'.
A total of 11 724 patients were eligible; 1712 (14.6%) had unsuppressed viral load within 6 months after initiating ART. The main marker of poor adherence was a combination of change in CD4 count and MCV; change in CD4 ≥expected and change in MCV <14.5 fL (RR 2.82, 95% CI 2.16-3.67), change in CD4 <expected and change in MCV <14.5 fL (RR 5.49, 95% CI 4.13-7.30) compared to change in CD4 ≥expected and change in MCV ≥14.5 fL.
A combination of less than expected increase in CD4 and MCV at 6 months after treatment initation was found to be a marker of poor adherence. This could help identify and monitor poor treatment adherence in the absence of viral load testing.
迄今为止，在资源有限的环境中，对于测量抗逆转录病毒治疗（ART）依从性的理想方法尚无共识。本研究旨在确定ART依从性差的标志物。
分析了2004年4月至2011年12月在南非约翰内斯堡海伦·约瑟夫医院的滕巴·莱图诊所开始接受标准一线ART治疗的未接受过ART治疗的HIV阳性成年患者的回顾性数据。使用具有稳健误差方差的泊松回归模型来评估以下依从性差的潜在标志物：“最后一次自我报告的依从性、错过的门诊就诊、平均红细胞体积（MCV）、根据依从性定义的CD4细胞计数、使用传统检测指标的HIV病毒载量抑制情况”。
共有11724名患者符合条件；1712名（14.6%）在开始ART治疗后6个月内病毒载量未得到抑制。依从性差的主要标志物是CD4细胞计数和MCV的变化组合；与CD4变化≥预期且MCV变化≥14.5 fL相比，CD4变化≥预期且MCV变化<14.5 fL（相对风险2.82，95%置信区间2.16 - 3.67），CD4变化<预期且MCV变化<14.5 fL（相对风险5.49，95%置信区间4.13 - 7.30）。
发现治疗开始后6个月CD4和MCV增加低于预期的组合是依从性差的一个标志物。这有助于在没有病毒载量检测的情况下识别和监测治疗依从性差的情况。
