Division of Epidemiology and Population Health, Department of Medicine, Stanford University, Stanford, CA, United States of America.
Division of Infectious Diseases, Department of Medicine, Stanford University, Stanford, CA, United States of America.
PLoS One. 2022 Feb 14;17(2):e0263742. doi: 10.1371/journal.pone.0263742. eCollection 2022.
Only a few recent reports have examined longitudinal adherence patterns in US clinics and its impact on immunological and virological outcomes among large cohorts initiating contemporary antiretroviral therapy (ART) in US clinics.
We followed all persons with HIV (PLWH) in a California clinic population initiating ART between 2010 and 2017. We estimated longitudinal adherence for each PLWH by calculating the medication possession ratio within multiple 6-month intervals using pharmacy refill records.
During the study, 2315 PWLH were followed for a median time of 210.8 weeks and only 179 (7.7%) were lost-to-follow-up. The mean adherence was 84.9%. Age (Hazard Ratio (HR): (95% confidence interval): 1.25 (1.20-1.31) per 10-year increase) and Black race (HR: 0.62 (0.53-0.73) vs. White) were associated with adherence in the cohort. A 10% percent increase in adherence increased the odds of being virally suppressed by 37% (OR and 95% CI: 1.37 [1.33-1.41]) and was associated with an increase in mean CD4 count by 8.54 cells/ul in the next 6-month interval (p-value <0.0001).
Our study shows that despite large improvements in retention in care, demographic disparities in adherence to ART persist. Adherence was lower among younger patients and black patients. Our study confirmed the strong association between adherence to ART and viral suppression but could only establish a weak association between adherence and CD4 count. These findings reaffirm the importance of adherence and retention in care and further highlight the need for tailored patient-centered HIV Care Models as a strategy to improve PLWH's outcomes.
仅有少数近期报告研究了美国诊所中纵向的依从模式及其对接受当代抗逆转录病毒疗法（ART）的大量队列的免疫和病毒学结局的影响。
我们随访了 2010 年至 2017 年期间在加利福尼亚诊所人群中接受 ART 治疗的所有 HIV 感染者（PLWH）。我们通过使用药房补药记录计算多个 6 个月间隔内的药物占有比，来估计每个 PLWH 的纵向依从性。
在研究期间，2315 名 PLWH 被随访了中位数为 210.8 周，仅有 179 名（7.7%）失访。平均依从率为 84.9%。年龄（风险比（HR）：（95%置信区间）：每增加 10 岁增加 1.25（1.20-1.31））和黑人种族（HR：0.62（0.53-0.73）与白人相比）与队列中的依从性相关。依从性增加 10%，病毒抑制的可能性增加 37%（比值比和 95%置信区间：1.37 [1.33-1.41]），并且在下一个 6 个月间隔内平均 CD4 计数增加 8.54 个/μl（p 值<0.0001）。
我们的研究表明，尽管在获得护理方面取得了很大的进展，但 ART 依从性方面仍存在人口统计学差异。年轻患者和黑人患者的依从性较低。我们的研究证实了 ART 依从性与病毒抑制之间的强关联，但仅能确立依从性与 CD4 计数之间的弱关联。这些发现再次证实了依从性和护理保留的重要性，并进一步强调了需要制定以患者为中心的 HIV 护理模式作为改善 PLWH 结局的策略。
