Nyaku Margaret, Beer Linda, Shu Fengjue
a Division of HIV/AIDS Prevention , Centers for Disease Control and Prevention , Atlanta , Georgia , USA.
b ICF International, Inc, assigned full-time to the Division of HIV/AIDS Prevention , Centers for Disease Control and Prevention.
AIDS Care. 2019 May;31(5):599-608. doi: 10.1080/09540121.2018.1533232. Epub 2018 Oct 11.
Not taking medicine over a specific period of time-non-persistence to antiretroviral therapy (ART)-may be associated with higher HIV-viral load. However, national estimates of non-persistence among U.S. HIV patients are lacking. We examined the association between non-persistence and various factors, including sustained HIV-viral suppression (VS) stratified by adherence, and assessed reasons for non-persistence using Medical Monitoring Project (MMP) data. MMP conducts clinical and behavioral surveillance among cross-sectional representative samples of adults receiving HIV care in the U.S. We analyzed weighted MMP interview and medical record abstraction data collected between 6/2011-5/2015 from 18,423 patients self-reporting ART use. We defined non-persistence as a self-initiated decision to not take ART for ≥2 consecutive days in the past 12-months, non-adherence as missing ≥1 ART dose during the past 3-days and sustained VS as all HIV-viral loads documented in medical record during the past 12-months as undetectable or <200 copies/mL. We used Rao-Scott chi-square tests to examine the association between non-persistence and sociodemographic, behavioral, clinical, and medication-related factors. We examined the association between non-persistence and sustained VS, stratified by adherence, and present prevalence ratios (PRs) with 95% confidence intervals (CIs). Reasons for non-persistence were assessed. Overall, 7% of patients reported non-persistence. Drug use, depression and medication side effects were associated with non-persistence (P < 0.01). Non-persistence was associated with the lack of sustained VS (PR: .66, CI:63-.70); this association did not differ by adherence level. However, VS was lower among the non-persistent/adherent compared with the persistent/non-adherent [51% (CI:47-54) versus 61% (CI:36-46), P < 0.01]. The most prevalent reason for non-persistence was treatment fatigue (38%). Though few persons in HIV care reported non-persistence, our findings suggest that non-persistence is associated with lack of sustained VS, regardless of adherence. Routine screening for non-persistence during clinical appointments and counseling for those at risk for non-persistence may help improve clinical outcomes.
在特定时间段内不服药——对抗逆转录病毒疗法（ART）不坚持——可能与更高的HIV病毒载量相关。然而，美国缺乏对HIV患者中不坚持情况的全国性估计。我们研究了不坚持与各种因素之间的关联，包括按依从性分层的持续HIV病毒抑制（VS），并使用医疗监测项目（MMP）的数据评估不坚持的原因。MMP在美国接受HIV治疗的成年人横断面代表性样本中开展临床和行为监测。我们分析了2011年6月至2015年5月期间从18423名自我报告使用ART的患者收集的加权MMP访谈和病历摘要数据。我们将不坚持定义为在过去12个月内自行决定连续≥2天不服ART，将不依从定义为在过去3天内漏服≥1剂ART，将持续VS定义为过去12个月内病历中记录的所有HIV病毒载量均不可检测或<200拷贝/毫升。我们使用Rao-Scott卡方检验来研究不坚持与社会人口统计学、行为、临床和药物相关因素之间的关联。我们研究了不坚持与持续VS之间的关联，按依从性分层，并给出患病率比（PRs）及95%置信区间（CIs）。评估了不坚持的原因。总体而言，7%的患者报告了不坚持情况。吸毒、抑郁和药物副作用与不坚持相关（P<0.01）。不坚持与缺乏持续VS相关（PR：0.66，CI：0.63 - 0.70）；这种关联在不同依从水平上没有差异。然而，与坚持/不依从者相比，不坚持/依从者的VS较低[51%（CI：47 - 54）对61%（CI：36 - 46），P<0.01]。不坚持最常见的原因是治疗疲劳（38%）。尽管接受HIV治疗的人中很少有人报告不坚持情况，但我们的研究结果表明，无论依从性如何，不坚持都与缺乏持续VS相关。在临床预约期间对不坚持情况进行常规筛查，并对有不坚持风险的人进行咨询，可能有助于改善临床结果。
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