Department of Public Health Sciences, Clemson University, Clemson, South Carolina, USA.
Clemson University School of Health Research, Clemson University, Clemson, South Carolina, USA.
Clin Infect Dis. 2021 Dec 6;73(11):2093-2100. doi: 10.1093/cid/ciab334.
Adequate medication adherence is critical for achieving sustained viral response (SVR) of hepatitis C virus (HCV) among people who inject drugs (PWID). However, it is less known which patterns of direct-acting antiviral (DAA) treatment adherence are associated with SVR in this population or what factors are associated with each pattern.
The randomized 3-arm PREVAIL study used electronic blister packs to obtain daily time frame adherence data in opiate agonist therapy program settings. Exact logistic regressions were applied to test the associations between SVR and 6 types of treatment adherence patterns.
Of the 113 participants treated with combination DAAs, 109 (96.5%) achieved SVR. SVR was significantly associated with all pattern parameters except for number of switches between adherent and missed days: total adherent daily doses (exact adjusted odds ratio [AOR] = 1.12; 95% confidence interval [CI] = 1.04-1.22), percent total doses (1.09; 1.03-1.16), days on treatment (1.16; 1.05-1.32), maximum consecutive adherent days (1.34; 1.06-2.04), and maximum consecutive nonadherent days (0.85; .74-.95 = 0.003). SVR was significantly associated with total adherent doses in the first 2 months of treatment, it was not in the last month. While alcohol intoxication was significantly associated with frequent switches, drug use was not associated with any adherence pattern.
Consistent maintenance of adequate total dose adherence over the entire course of HCV treatment is important in achieving SVR among PWID. Additional integrative addiction and medical care may be warranted for treating PWID who experience alcohol intoxication.
在注射毒品人群（PWID）中，充分的药物依从性对于实现丙型肝炎病毒（HCV）的持续病毒学应答（SVR）至关重要。然而，在该人群中，哪种直接作用抗病毒（DAA）治疗依从模式与 SVR 相关，以及哪些因素与每种模式相关，知之甚少。
随机 3 臂 PREVAIL 研究在阿片类激动剂治疗方案环境中使用电子泡罩包装来获得每日时间框架依从性数据。精确逻辑回归用于检验 SVR 与 6 种治疗依从模式之间的关联。
在接受联合 DAA 治疗的 113 名参与者中，有 109 名（96.5%）实现了 SVR。SVR 与除了每天在坚持和漏服天数之间的转换次数之外的所有模式参数显著相关：总坚持日剂量（确切调整后的优势比[OR]为 1.12；95%置信区间[CI]为 1.04-1.22），总剂量百分比（1.09；1.03-1.16），治疗天数（1.16；1.05-1.32），最长连续坚持天数（1.34；1.06-2.04）和最长连续非坚持天数（0.85；0.74-0.95=0.003）。SVR 与治疗前 2 个月的总坚持剂量显著相关，但与最后一个月的剂量无关。虽然酒精中毒与频繁转换显著相关，但药物使用与任何依从模式均无关。
在 PWID 中实现 SVR ，在整个 HCV 治疗过程中始终如一地维持足够的总剂量依从性非常重要。对于经历酒精中毒的 PWID，可能需要额外的综合成瘾和医疗护理。
