博茨瓦纳青少年艾滋病毒感染者的药房续方数据对病毒学治疗结果的预测效果不佳。
Pharmacy Refill Data are Poor Predictors of Virologic Treatment Outcomes in Adolescents with HIV in Botswana.
机构信息
Children's Hospital of Philadelphia, Philadelphia, PA, USA.
Masters of Public Health Program, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA.
出版信息
AIDS Behav. 2019 Aug;23(8):2130-2137. doi: 10.1007/s10461-018-2325-9.
In adults living with HIV, pharmacy refill data are good predictors of virologic failure (VF). The utility of pharmacy refill data for predicting VF in adolescents has not been reported. We evaluated data from 291 adolescents on antiretroviral therapy. The main outcome measure was VF, defined as two consecutive HIV viral load measurements ≥ 400 copies/mL during 24-months of follow-up. Pharmacy refill non-adherence was defined as two consecutive refill adherence measurements < 95% during the same period. Fifty-three (18%) adolescents experienced VF. One hundred twenty-eight (44%) adolescents had refill non-adherence. Refill non-adherence had poor discriminative ability for indicating VF (receiver operating characteristic AUC = 0.60). Sensitivity and specificity for predicting VF was poor (60% (95% CI 46-74%) and 60% (95% CI 53-66%), respectively). The lack of a viable surrogate for VF in adolescents highlights the urgent need for more access to virologic testing and novel methods of monitoring adolescent treatment adherence.
在 HIV 感染者成年人中，药物续配数据是病毒学失败 (VF) 的良好预测指标。药物续配数据在预测青少年 VF 中的应用尚未见报道。我们评估了 291 名接受抗逆转录病毒治疗的青少年的数据。主要结局指标为 VF，定义为在 24 个月的随访中连续两次 HIV 病毒载量测量值≥400 拷贝/ml。在此期间，药物续配不依从被定义为两次连续的续配依从性测量值<95%。53 名（18%）青少年发生了 VF。128 名（44%）青少年药物续配不依从。药物续配不依从对指示 VF 的区分能力较差（受试者工作特征曲线 AUC=0.60）。预测 VF 的敏感性和特异性均较差（60%（95% CI 46-74%）和 60%（95% CI 53-66%））。青少年中缺乏有效的 VF 替代指标，突出表明迫切需要更多的病毒学检测和新的监测青少年治疗依从性的方法。
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