美国各地 HIV-1 患者的抗逆转录病毒治疗真实世界依从性。

Real-World Adherence to Antiretroviral Therapy Among HIV-1 Patients Across the United States.

机构信息

University Hospitals of Cleveland and Case Western Reserve University, Cleveland, OH, USA.

Novosys Health, Green Brook, NJ, USA.

出版信息

Adv Ther. 2021 Sep;38(9):4961-4974. doi: 10.1007/s12325-021-01883-8. Epub 2021 Aug 14.

INTRODUCTION

Recent changes in antiretroviral therapies (ARTs) may have affected medication adherence of people living with human immunodeficiency virus-1 (HIV-1). In this study adherence to ART regimens among patients with HIV-1 (PWH) across the US during a recent time period was examined and study findings were stratified by US region and state.

METHODS

A retrospective observational study using the Symphony Health Solution Integrated Dataverse database was conducted. Patients ≥ 18 years of age who had a diagnosis of HIV-1 (without an HIV-2 diagnosis) and who were treated with ART between July 2017 and September 2018 (first pharmacy record: index date) were selected from the data source. Both patients who had not been previously treated with ART and those who were treatment experienced were included. Patients were required to have ≥ 1 medical/pharmacy record ≥ 12 months after their index date (follow-up period). Patient characteristics were examined during a 12-month pre-index period. During the follow-up, medication adherence, measured as the proportion of days covered (PDC), was examined for all patients and stratified by US region and state.

RESULTS

Among 206,474 adult PWH treated with ART, mean age was 47.9 years, 73.4% were male, and 30.0% were Caucasian. The most prevalent comorbid conditions were hyperlipidemia (25.1%), depressive disorders (14.8%), and type 2 diabetes (12.1%). During the follow-up period, mean (standard deviation) PDC was 74.1% (25.9%) among PWH across the US [Midwest: 74.4% (25.5%); Northeast: 74.3% (26.1%); South: 73.2% (26.3%); West: 76.4% (24.8%)]. Across all US regions, > 60% of PWH had adherence < 90% and > 40% had adherence < 80%; the West had the highest adherent population.

CONCLUSIONS

Among PWH treated with ART across the US, a majority had suboptimal adherence. Implementation of strategies to improve ART adherence, including clinical consideration of ARTs with high genetic barriers to resistance, is needed in the US.

简介

抗逆转录病毒疗法（ART）的近期变化可能影响了人类免疫缺陷病毒-1（HIV-1）感染者的药物依从性。在这项研究中，检查了美国最近一段时间内 HIV-1 感染者（PWH）的 ART 方案依从性，并按美国地区和州进行了分层。

方法

使用 Symphony Health Solution Integrated Dataverse 数据库进行了一项回顾性观察性研究。从数据源中选择了 2017 年 7 月至 2018 年 9 月（首次药房记录：索引日期）期间接受过 HIV-1 治疗（无 HIV-2 诊断）且年龄≥18 岁的患者。包括既往未接受过 ART 治疗的患者和治疗经验丰富的患者。要求患者在索引日期后至少有 1 份≥12 个月的医疗/药房记录（随访期）。在 12 个月的索引前期间检查了患者特征。在随访期间，检查了所有患者的药物依从性，以覆盖率（PDC）的比例表示，并按美国地区和州进行了分层。

结果

在接受 ART 治疗的 206474 名成年 PWH 中，平均年龄为 47.9 岁，73.4%为男性，30.0%为白种人。最常见的合并症是血脂异常（25.1%）、抑郁障碍（14.8%）和 2 型糖尿病（12.1%）。在随访期间，美国 PWH 的平均（标准差）PDC 为 74.1%（25.9%）[中西部：74.4%（25.5%）；东北部：74.3%（26.1%）；南部：73.2%（26.3%）；西部：76.4%（24.8%）]。在美国所有地区，超过 60%的 PWH 的依从性<90%，超过 40%的依从性<80%；西部地区的依从性最高。