乌干达农村地区长期接受抗逆转录病毒治疗的患者中，坚持治疗咨询对逆转病毒学失败无效。
Lack of effectiveness of adherence counselling in reversing virological failure among patients on long-term antiretroviral therapy in rural Uganda.
机构信息
The AIDS Support Organisation (TASO), Kampala, Uganda.
Medical Research Council/Uganda Virus Research Institute & London School of Hygiene and Tropical Medicine, Uganda Research Unit on AIDS, Entebbe, Uganda.
出版信息
HIV Med. 2020 Jan;21(1):21-29. doi: 10.1111/hiv.12790. Epub 2019 Aug 21.
OBJECTIVES
The current World Health Organization and Uganda Ministry of Health HIV treatment guidelines recommend that asymptomatic patients who have a viral load (VL) ≥ 1000 HIV-1 RNA copies/mL should receive adherence counselling and repeat VL testing before switching to second-line therapy. We evaluated the effectiveness of this strategy in a large HIV treatment programme of The AIDS Support Organisation Jinja in Jinja, Uganda.
METHODS
We measured the HIV VL at enrolment, and for participants with VL ≥ 1000 copies/mL we informed them of their result, offered enhanced adherence counselling and repeated the VL measurement after 3 months. All blood samples with VL ≥ 1000 copies/mL were sequenced in the polymerase (pol) region, a 1257-bp fragment spanning the protease and reverse transcriptase genes.
RESULTS
One thousand and ninety-one participants were enrolled in the study; 74.7% were female and the median age was 44 years [interquartile range (IQR) 39-50 years]. The median time on antiretroviral therapy (ART) at enrolment was 6.75 years (IQR 5.3-7.6 years) and the median CD4 cell count was 494 cells/μL (IQR 351-691 cells/μL). A total of 113 participants (10.4%) had VLs ≥ 1000 copies/mL and were informed of the VL result and its implications and given adherence counselling. Of these 113 participants, 102 completed 3 months of follow-up and 93 (91%) still had VLs ≥ 1000 copies/mL. We successfully genotyped HIV for 105 patients (93%) and found that 103 (98%) had at least one mutation: eight (7.6%) had only one mutation, 94 (89.5%) had two mutations and one sample (1%) had three mutations.
CONCLUSIONS
In this study, enhanced adherence counselling was not effective in reversing virologically defined treatment failure for patients on long-term ART who had not previously had a VL test.
目的
目前，世界卫生组织和乌干达卫生部的艾滋病毒治疗指南建议，病毒载量（VL）≥1000 HIV-1 RNA 拷贝/ml 的无症状患者应在转为二线治疗前接受依从性咨询和重复 VL 检测。我们在乌干达 Jinja 的艾滋病支持组织 Jinja 的一个大型艾滋病毒治疗计划中评估了该策略的有效性。
方法
我们在入组时测量了 HIV VL，并对 VL≥1000 拷贝/ml 的参与者告知其结果，提供了强化的依从性咨询，并在 3 个月后重复了 VL 测量。所有 VL≥1000 拷贝/ml 的血液样本均在聚合酶（pol）区域进行测序，该区域为跨越蛋白酶和逆转录酶基因的 1257 个碱基片段。
结果
共有 1091 名参与者入组研究；74.7%为女性，中位年龄为 44 岁[四分位距（IQR）39-50 岁]。入组时抗逆转录病毒治疗（ART）的中位时间为 6.75 年（IQR 5.3-7.6 年），中位 CD4 细胞计数为 494 个/μL（IQR 351-691 个/μL）。共有 113 名（10.4%）参与者的 VL≥1000 拷贝/ml，他们被告知了 VL 结果及其影响，并接受了依从性咨询。在这 113 名参与者中，有 102 名完成了 3 个月的随访，其中 93 名（91%）仍有 VL≥1000 拷贝/ml。我们成功对 105 名患者（93%）进行了 HIV 基因分型，发现其中 103 名（98%）至少有一种突变：8 名（7.6%）仅有一种突变，94 名（89.5%）有两种突变，一个样本（1%）有三种突变。
结论
在这项研究中，强化的依从性咨询并没有有效地逆转长期接受 ART 治疗且之前没有进行 VL 检测的患者在病毒学上定义的治疗失败。
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