Been Sabrina K, Yildiz Elif, Nieuwkerk Pythia T, Pogány Katalin, van de Vijver David A M C, Verbon Annelies
Department of Internal Medicine, division of Infectious Diseases, Erasmus University Medical Center, Rotterdam, The Netherlands.
Department of Medical Microbiology and Infectious Diseases, Erasmus University Medical Center, Rotterdam, The Netherlands.
PLoS One. 2017 Nov 9;12(11):e0186912. doi: 10.1371/journal.pone.0186912. eCollection 2017.
HIV-infected migrants were shown to have poorer treatment outcomes than Dutch HIV-infected patients, often due to worse treatment adherence. Self-reported adherence would be an easy way to monitor adherence, but its validity relative to pharmacy refill adherence has not been extensively evaluated in migrants. All HIV-infected migrants older than 18 years and in care at the two Rotterdam HIV-treatment centers were eligible. Refill data with leftover medication (PRL) (residual pill count) were obtained from their pharmacies up to 15 months prior to inclusion. Self-reported adherence to combination Antiretroviral Therapy was assessed by four questions about adherence at inclusion. Additionally, risk factors for pharmacy refill non-adherence were examined. In total, 299 HIV-infected migrants were included. Viral load (VL) was detectable in 11% of the patients. Specificity of PRL was 53% for patients with an adherence of 100% and decreased with lower cut-off values. Sensitivity and negative predictive value (NPV) were 68% and 15% and increased with lower cut-off values. Positive predictive value (PPV) was around 93% for all cut-off values. Using the self-reported questions, 139 patients (47%) reported to be adherent. Sensitivity was 49% and specificity was 72%. PPV and NPV were 95% and 13%. No risk factors for pharmacy refill non-adherence were found in multivariable analyses. Both PRL and self-reported adherence, can predict undetectable VL in HIV-infected migrants. PPV and NPV are similar for both methods. This study shows that using four self-reported items is sufficient to predict adherence which is crucial for optimal clinical outcome in HIV-infected migrants.
研究表明，感染艾滋病毒的移民的治疗效果比荷兰感染艾滋病毒的患者更差，这通常是由于治疗依从性较差。自我报告的依从性是监测依从性的一种简便方法，但相对于药房配药依从性而言，其有效性在移民中尚未得到广泛评估。所有年龄在18岁以上且在鹿特丹两个艾滋病毒治疗中心接受治疗的感染艾滋病毒的移民均符合条件。在纳入研究前15个月内，从他们的药房获取了剩余药物的配药数据（PRL）（剩余药丸计数）。通过四个关于纳入时依从性的问题评估了自我报告的抗逆转录病毒联合疗法依从性。此外，还研究了药房配药不依从的风险因素。总共纳入了299名感染艾滋病毒的移民。11%的患者病毒载量（VL）可检测到。对于依从性为100%的患者，PRL的特异性为53%，并随着截断值降低而下降。敏感性和阴性预测值（NPV）分别为68%和15%，并随着截断值降低而增加。所有截断值的阳性预测值（PPV）约为93%。使用自我报告的问题，139名患者（47%）报告依从。敏感性为49%，特异性为72%。PPV和NPV分别为95%和13%。多变量分析未发现药房配药不依从的风险因素。PRL和自我报告的依从性都可以预测感染艾滋病毒移民中无法检测到的VL。两种方法的PPV和NPV相似。这项研究表明，使用四个自我报告项目足以预测依从性，这对于感染艾滋病毒移民的最佳临床结果至关重要。
