Nutt Cameron T, Muyindike Winnie R, Nanfuka Victoria, Komukama Nimusiima, Barigye Ian T, Kansiime Lydia, Tumusiime Justus, Omoding Daniel, Aung Taing N, Stuckwisch Ashley, Hedt-Gauthier Bethany, Hoeppner Susanne S, Marconi Vincent C, Moosa Mahomed-Yunus S, Gupta Ravindra K, Siedner Mark J, McCluskey Suzanne M
Medical Practice Evaluation Center, Massachusetts General Hospital, Boston, Massachusetts, USA.
Division of Infectious Diseases, Massachusetts General Hospital, Boston, Massachusetts, USA.
J Acquir Immune Defic Syndr. 2025 Aug 4. doi: 10.1097/QAI.0000000000003735.
Tenofovir/lamivudine/dolutegravir (TLD) is now the most prescribed antiretroviral therapy (ART) regimen worldwide. While effective and well-tolerated, dolutegravir has been associated with weight gain and neuropsychiatric symptoms. The relationship between these adverse effects and adherence to TLD has not been well characterized.
We conducted a secondary analysis of a prospective cohort study that followed 675 adults with HIV for 48 weeks in southwestern Uganda after they either transitioned to TLD from older ART regimens or newly initiated ART with TLD. At study weeks 0, 24, and 48, participants completed questionnaires assessing self-reported adherence, use of non-HIV medications, and symptoms. Clinical parameters related to HIV and opportunistic infections were obtained by chart review. Generalized estimating equation logistic regression models were fit to assess factors associated with incomplete adherence.
642 participants (95.1%; median age 44 years; 45.6% female) contributed data for at least two study visits. Incomplete adherence to TLD was rare overall, reported by 54 participants (8.4%) through 48 weeks. Incident headaches were associated with incomplete adherence (aOR 1.68; 95% CI: 1.03-2.76; p=0.04), whereas previous ART experience (aOR 0.38; 95% CI 0.21-0.70; p≤0.01) and prescription of ≥1 non-HIV medication (aOR 0.48; 95% CI: 0.29-0.79; p≤0.01) predicted better adherence. We found no relationship between perceived weight gain and incomplete adherence (aOR 0.39; 95% CI: 0.11-1.39; p=0.15).
Incident headaches were associated with incomplete adherence to TLD in southwestern Uganda, while established pill-taking routines were associated with better adherence. Dolutegravir-associated weight gain did not impact adherence in this setting.
替诺福韦/拉米夫定/多替拉韦（TLD）目前是全球处方量最多的抗逆转录病毒治疗（ART）方案。多替拉韦虽然有效且耐受性良好，但与体重增加和神经精神症状有关。这些不良反应与TLD依从性之间的关系尚未得到充分描述。
我们对一项前瞻性队列研究进行了二次分析，该研究在乌干达西南部追踪了675名感染HIV的成年人48周，这些人要么从旧的ART方案转换为TLD，要么新开始使用TLD进行ART治疗。在研究的第0、24和48周，参与者完成了问卷调查，评估自我报告的依从性、非HIV药物的使用情况和症状。通过查阅病历获得与HIV和机会性感染相关的临床参数。采用广义估计方程逻辑回归模型来评估与不完全依从相关的因素。
642名参与者（95.1%；中位年龄44岁；45.6%为女性）为至少两次研究访视提供了数据。总体而言，对TLD的不完全依从很少见，在48周内有54名参与者（8.4%）报告了这种情况。新发头痛与不完全依从相关（调整后的比值比[aOR]为1.68；95%置信区间[CI]：1.03 - 2.76；p = 0.04），而既往ART治疗经验（aOR为0.38；95% CI为0.21 - 0.70；p≤0.01）和开具≥1种非HIV药物的处方（aOR为0.48；95% CI：0.29 - 0.79；p≤0.01）预示着更好的依从性。我们发现自觉体重增加与不完全依从之间没有关系（aOR为0.39；95% CI：0.11 - 1.39；p = 0.15）。
在乌干达西南部，新发头痛与不完全依从TLD有关，而既定的服药习惯与更好的依从性有关。在这种情况下，多替拉韦相关的体重增加并未影响依从性。
