Milward de Azevedo Meiners Micheline Marie, Araújo Cruz Igor, de Toledo Maria Inês
Programa de Pós-Graduação em Medicina Tropical, Faculdade de Medicina, Universidade de Brasília, Brasília, Brazil.
Curso de Farmácia e Grupo de Pesquisa Acesso a Medicamentos e Uso Responsável (AMUR), Faculdade de Ceilândia, Universidade de Brasília, Brasília, Brazil.
Front Pharmacol. 2023 Mar 31;14:1122018. doi: 10.3389/fphar.2023.1122018. eCollection 2023.
The increased effectiveness of antiretroviral therapy (ART) in the last 30 years is a scientific landmark, and viral suppression is directly associated with treatment adherence. The aim of this study was to compare the results of ART adherence and viral load suppression with the evolution of the protocols and other associated factors, in people living with HIV. A panel analysis of three descriptive longitudinal studies investigating ART adherence and viral load suppression was conducted in people with HIV treated at a drug dispensing unit in the Federal District. The studies were carried out during periods of 2011, 2013, and 2017, coinciding with the three different recommended treatment schemes for the country. Adherence was assessed using drug dispensing records. Viral load data were obtained from the Ministry of Health's Laboratory Examination Information System. Analysis of the data of 522 individuals in the three periods showed sociodemographic differences such as a decline in the percentage of women (from 33% in period 1 to 4% in period 3) and an increase in the percentage of young people. ART adherence was higher in period 2 (tenofovir/lamivudine/efavirenz scheme). Viral load suppression was greater in period 3 (tenofovir/lamivudine/dolutegravir scheme). The relative detectable viral load risk was nearly two-fold higher (RR 1.83) in people living with HIV with less than 80% adherence when compared to those above 80%. With respect to the different schemes recommended in Brazil during the periods studied, ART containing dolutegravir was the most effective in achieving viral load suppression. By contrast, there was better ART adherence in the daily combined fixed dose consisting of tenofovir/lamivudine/efavirenz in tablet form. Adherence to ART above 80% seemed to be enough to promote an effective treatment in therapeutic schemes including efavirenz or dolutegravir.
过去30年中抗逆转录病毒疗法（ART）有效性的提高是一项科学里程碑，病毒抑制与治疗依从性直接相关。本研究的目的是比较HIV感染者中ART依从性和病毒载量抑制结果与治疗方案的演变及其他相关因素。对在联邦区一个药品分发单位接受治疗的HIV感染者进行了三项描述性纵向研究的面板分析，以调查ART依从性和病毒载量抑制情况。这些研究在2011年、2013年和2017年期间进行，与该国三种不同的推荐治疗方案相吻合。使用药品分发记录评估依从性。病毒载量数据从卫生部的实验室检查信息系统获得。对三个时期522名个体的数据进行分析显示，存在社会人口统计学差异，如女性比例下降（从第1期的33%降至第3期的4%）和年轻人比例增加。第2期（替诺福韦/拉米夫定/依非韦伦方案）的ART依从性更高。第3期（替诺福韦/拉米夫定/多替拉韦方案）的病毒载量抑制效果更好。依从性低于80%的HIV感染者的相对可检测病毒载量风险比高于80%的感染者高出近两倍（相对风险1.83）。在所研究的时期内，就巴西推荐的不同方案而言，含多替拉韦的ART在实现病毒载量抑制方面最有效。相比之下，替诺福韦/拉米夫定/依非韦伦片剂形式的每日联合固定剂量的ART依从性更好。在包括依非韦伦或多替拉韦的治疗方案中，ART依从性高于80%似乎足以促进有效治疗。
