Desmond Tutu Health Foundation, Institute of Infectious Diseases and Molecular Medicine and the Department of Medicine, University of Cape Town, Cape Town, South Africa.
HIV Center for Clinical and Behavioral Studies, New York State Psychiatric Institute and Columbia University, New York, NY.
J Acquir Immune Defic Syndr. 2023 Aug 1;93(4):327-332. doi: 10.1097/QAI.0000000000003198. Epub 2023 Mar 24.
Electronic adherence (EA) and tenofovir diphosphate (TFV-DP) in dried blood spots (DBS) are objective measures of antiretroviral therapy (ART) adherence. We characterized the association between these measures in a prospective cohort of persons with HIV (PWH) on ART.
Four primary health clinics in Cape Town, South Africa.
We enrolled 250 virally suppressed PWH receiving tenofovir-based ART. We collected EA data, monthly viral load, and TFV-DP in DBS for 12 months. We used logistic regression to estimate the adjusted odds ratio (aOR) and 95% confidence intervals (CIs) for future viral breakthrough (VB) (>400 copies/mL) for each adherence measure. Receiver operating characteristics (ROCs) provided the predictive power of these measures.
Participants had a median (IQR) age of 34 (27-42); 78% were women. Twenty-one (8%) developed VB. Logistic regression showed that when percent EA and TFV-DP concentrations increased, the odds of VB decreased. This relationship was consistent at the time of VB (aOR of 0.41 [95% CI: 0.25 to 0.66] for TFV-DP and aOR of 0.64 [95% CI: 0.54 to 0.76] for EA) and for up to 2 months before VB. Both adherence measures predicted future VB at both 1 month and 2 months before viral load measurement.
We established that 2 objective adherence measures, EA and TFV-DP in DBS, have a positive association with, and are both strongly predictive of, VB in a community-based South African cohort on ART. Future research is needed to determine the feasibility of implementing these adherence measures in resource-limited settings to facilitate adherence interventions.
电子依从性（EA）和替诺福韦二磷酸（TFV-DP）在干血斑（DBS）中是抗逆转录病毒治疗（ART）依从性的客观测量指标。我们在接受基于替诺福韦的 ART 的 HIV 感染者（PWH）前瞻性队列中描述了这些措施之间的关联。
南非开普敦的 4 个初级保健诊所。
我们招募了 250 名病毒抑制的接受基于替诺福韦的 ART 的 PWH。我们收集了 12 个月的 EA 数据、每月病毒载量和 DBS 中的 TFV-DP。我们使用逻辑回归估计每个依从性指标对未来病毒突破（VB）（>400 拷贝/mL）的校正优势比（aOR）和 95%置信区间（CI）。接受者操作特征（ROC）提供了这些措施的预测能力。
参与者的中位（IQR）年龄为 34（27-42）；78%为女性。21 人（8%）发生 VB。逻辑回归显示，当 EA 和 TFV-DP 的百分比增加时，VB 的几率降低。这种关系在 VB 时是一致的（TFV-DP 的 aOR 为 0.41 [95%CI：0.25 至 0.66]，EA 的 aOR 为 0.64 [95%CI：0.54 至 0.76]），并且在 VB 前长达 2 个月。这两种依从性指标在病毒载量测量前 1 个月和 2 个月都能预测未来的 VB。
我们确定了 2 种客观的依从性指标，EA 和 DBS 中的 TFV-DP，与南非社区接受 ART 的 PWH 的 VB 呈正相关，并且都具有很强的预测性。需要进一步研究在资源有限的环境中实施这些依从性措施的可行性，以促进依从性干预。
