资源有限环境下基于多替拉韦的治疗方案的病毒学抑制及其相关因素：埃塞俄比亚的一项观察性回顾性研究
Virological Suppression and Its Associated Factors of Dolutegravir Based Regimen in a Resource-Limited Setting: An Observational Retrospective Study in Ethiopia.
作者信息
Mehari Eden Abetu, Muche Esileman Abdela, Gonete Kedir Abdela
机构信息
Department of Clinical Pharmacy, School of Pharmacy, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia.
Department of Human Nutrition, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia.
出版信息
HIV AIDS (Auckl). 2021 Jun 29;13:709-717. doi: 10.2147/HIV.S316776. eCollection 2021.
BACKGROUND
Toxicity, treatment failure, and resistance to existing HIV treatment regimens have become a challenge in resource-limited settings. As a result, a dolutegravir based regimen has recently been utilized. However, there is a paucity of evidence in sub-Saharan countries regarding its virological suppression. Thus, this study aimed to assess virological suppression and associated factors of dolutegravir based regimen.
METHODS
A retrospective follow-up study was conducted on 349 individuals. They were selected using a systematic random sampling technique among all treatment-experienced adult HIV patients who were on a dolutegravir based regimen. From this, 81.4% of them were virologically suppressed before the initiation of dolutegravir based regimen. The study was carried out at twelve months of therapy after shifting to dolutegravir based regimen (TDF-3TC-DTG) during the period May 2018-August 2020 at Debre Markos referral hospital. Retrospective data before and after dolutegravir based regimen initiation were collected from their medical records. The time on dolutegravir based regimen was one year. Bivariable and multivariable logistic regression was used to identify factors. Variables with p <0.05 were considered statistically significant.
RESULTS
From a total of 359, 349 participated (97.2%) in the study, and the mean age of the participants was 40.28 ±11.6 years. Totally, 192 (55.0%) of them were female. The proportion of virological suppression was 92%. Good adherence (participants who reported an intake of ≥95% of the prescribed medication) (AOR=6.2, 95% CI: 1.93, 20.11) and overall duration of ART (AOR=1.02, 95% CI: 1.01, 1.04) were associated with virological suppression.
CONCLUSION
Dolutegravir based regimen maintains high virological suppression. Adherence and duration of ART were associated with virological suppression. Therefore, designing effective mechanisms to maintain virological suppression is important.
背景
毒性、治疗失败以及对现有抗逆转录病毒治疗方案产生耐药性已成为资源有限地区面临的一项挑战。因此，最近采用了基于多替拉韦的治疗方案。然而，撒哈拉以南国家在其病毒学抑制方面的证据很少。因此，本研究旨在评估基于多替拉韦的治疗方案的病毒学抑制情况及相关因素。
方法
对349名个体进行了一项回顾性随访研究。他们是在所有接受过治疗的、采用基于多替拉韦治疗方案的成年艾滋病患者中，使用系统随机抽样技术选取的。其中，81.4%的患者在开始基于多替拉韦的治疗方案之前病毒学得到抑制。该研究于2018年5月至2020年8月期间在德布雷马科斯转诊医院进行，在转换为基于多替拉韦的治疗方案（替诺福韦-拉米夫定-多替拉韦）12个月后开展。从他们的病历中收集了开始基于多替拉韦的治疗方案前后的回顾性数据。基于多替拉韦的治疗方案使用时间为一年。采用双变量和多变量逻辑回归来确定相关因素。p<0.05的变量被认为具有统计学意义。
结果
在总共359名中，349名（97.2%）参与了研究，参与者的平均年龄为40.28±11.6岁。其中共有192名（55.0%）为女性。病毒学抑制率为92%。良好的依从性（报告服用规定药物≥95%的参与者）（调整后比值比=6.2，95%置信区间：1.93，20.11）和抗逆转录病毒治疗的总疗程（调整后比值比=1.02，95%置信区间：1.01，1.04）与病毒学抑制相关。
结论
基于多替拉韦的治疗方案能维持较高的病毒学抑制率。依从性和抗逆转录病毒治疗疗程与病毒学抑制相关。因此，设计有效的机制来维持病毒学抑制很重要。
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