Hemmige Vagish, Flash Charlene A, Carter Josephinel, Giordano Thomas P, Zerai Teddy
a Division of Infectious Diseases , Baylor College of Medicine , Houston , TX , USA.
b Harris Health System , Houston , TX , USA.
AIDS Care. 2018 Aug;30(8):1017-1024. doi: 10.1080/09540121.2018.1442554. Epub 2018 Feb 25.
Newer HIV regimens are typically taken once daily but vary in the number of pills required. Whether the number of pills in a once-daily HIV regimen affects clinical outcomes is unknown. We retrospectively compared adherence, retention in care, and virologic outcomes between patients starting a once daily single-tablet regimen (STR) to patients starting a once-daily multi-tablet regimen (MTR) in a publicly funded clinic in the United States. Outcomes were measured in the year after starting ART and included retention in care, virologic suppression, and medication possession ratio of at least 80%. Data from patients initiating therapy from 1 January 2008 to 31 December 2011 were analyzed with both unadjusted and propensity-score adjusted regression. Overall, 622 patients started with an STR (100% efavirenz-based) and 406 with an MTR (65% atazanavir-based and 35% darunavir-based) regimen. Retention in care was achieved in 80.7% of STR patients vs. 72.7% of MTR patients (unadjusted OR 1.57, 95% CI 1.17-2.11; adjusted OR 1.49, 95% CI 1.10-2.02). Virologic suppression occurred among 84.4% of STR patients vs. 77.6% of MTR patients (unadjusted OR 1.56; 95% CI 1.14-2.15; adjusted OR 1.41; 95% CI 1.02-1.96). There was no difference in the proportion of patients achieving at least 80% adherence, as measured by medication possession ratio (33.0% of STR patients and 30.1% of MTR patients; unadjusted OR 1.14; 95% CI 0.87-1.50; adjusted OR 1.04, CI 0.79-1.38). While it is difficult to eliminate confounding in this observational study, retention in care and virologic outcomes were better in patients prescribed STRs.
较新的抗HIV治疗方案通常每天服用一次，但所需药片数量各不相同。每日一次的抗HIV治疗方案中的药片数量是否会影响临床结果尚不清楚。我们在美国一家公共资助诊所中，对开始每日一次单片治疗方案（STR）的患者与开始每日一次多片治疗方案（MTR）的患者的依从性、持续治疗率和病毒学结果进行了回顾性比较。在开始抗逆转录病毒治疗（ART）后的一年中对结果进行测量，包括持续治疗率、病毒学抑制以及药物持有率至少达到80%。对2008年1月1日至2011年12月31日开始治疗的患者数据进行了未调整和倾向得分调整回归分析。总体而言，622例患者开始使用STR方案（100%基于依非韦伦），406例患者开始使用MTR方案（65%基于阿扎那韦，35%基于达芦那韦）。STR组患者的持续治疗率为80.7%，而MTR组患者为72.7%（未调整比值比1.57，95%置信区间1.17 - 2.11；调整后比值比1.49，95%置信区间1.10 - 2.02）。STR组患者中84.4%实现了病毒学抑制，而MTR组患者为77.6%（未调整比值比1.56；95%置信区间1.14 - 2.15；调整后比值比1.41；95%置信区间1.02 - 1.96）。通过药物持有率衡量，达到至少80%依从性的患者比例没有差异（STR组患者为33.0%，MTR组患者为30.1%；未调整比值比1.14；95%置信区间0.87 - 1.50；调整后比值比1.04，置信区间0.79 - 1.38）。虽然在这项观察性研究中难以消除混杂因素，但接受STR方案治疗的患者在持续治疗率和病毒学结果方面更好。
