Division of Epidemiology and Biostatistics, Centre for Infectious Disease Epidemiology and Research, School of Public Health and Family Medicine, University of Cape Town, Cape Town, South Africa.
Department of Health Services, Policy and Practice, Brown University School of Public Health, Providence, RI.
J Acquir Immune Defic Syndr. 2019 Mar 1;80(3):247-254. doi: 10.1097/QAI.0000000000001909.
Routine HIV viral load (VL) monitoring is recommended for patients on antiretroviral therapy, but frequent VL testing, required in pregnant and postpartum women, is often not feasible. Self-reported adherence can be valuable, but little is known about its longitudinal characteristics.
We followed women living with HIV from antiretroviral therapy initiation in pregnancy through 18-month postpartum in Cape Town, South Africa, with repeated measurement of VL and self-reported adherence using a 3-item scale. We used generalized estimating equations [with results presented as odds ratios (ORs) with 95% confidence intervals (CIs)] to investigate the association between viremia and change in adherence over pairs of consecutive visits.
Among 2085 visit pairs from 433 women, a decrease in self-reported adherence relative to the previous visit on any of the 3 self-report items, or the combined scale, was associated with VL >50 and >1000 copies per milliliter. The best-performing thresholds to predict VL >50 copies per milliliter were a single-level decrease on the Likert response item "how good a job did you do at taking your HIV medicines in the way that you were supposed to?" (OR 2.08, 95% CI: 1.48 to 2.91), and a decrease equivalent to ≥5 missed doses or a one-level decrease in score on either of 2 Likert items (OR 1.34, 95% CI: 1.06 to 1.69).
Longitudinal changes in self-reported adherence can help identify patients with viremia. This approach warrants consideration in settings where frequent VL monitoring or other objective adherence measures are not possible.
建议对接受抗逆转录病毒治疗的患者进行常规 HIV 病毒载量（VL）监测，但在孕妇和产后妇女中，频繁的 VL 检测往往不可行。自我报告的依从性可能很有价值，但人们对其纵向特征知之甚少。
我们在南非开普敦对从妊娠开始接受抗逆转录病毒治疗的 HIV 感染者进行了前瞻性研究，在 18 个月的产后期间，通过重复测量 VL 和使用 3 项量表报告的依从性，对她们进行了随访。我们使用广义估计方程[结果以比值比（OR）和 95%置信区间（CI）表示]，以调查病毒血症与连续两次就诊时依从性变化之间的关系。
在 433 名女性的 2085 对就诊中，与前一次就诊相比，任何 3 项自我报告项目或综合量表中的自我报告依从性下降，与 VL>50 和>1000 拷贝/毫升有关。预测 VL>50 拷贝/毫升的最佳阈值是“你按规定服药治疗 HIV 的效果如何？”Likert 回答项目中单个级别的下降（OR 2.08，95%CI：1.48 至 2.91），以及相当于漏服≥5 剂或 2 个 Likert 项目中任何一个项目得分下降一个级别（OR 1.34，95%CI：1.06 至 1.69）。
自我报告依从性的纵向变化有助于识别病毒血症患者。在无法进行频繁的 VL 监测或其他客观依从性测量的情况下，这种方法值得考虑。
