基于真实世界数据评估实现 HIV 病毒抑制所需的抗逆转录病毒药物依从性水平。
Antiretroviral Adherence Level Necessary for HIV Viral Suppression Using Real-World Data.
机构信息
Division of HIV/AIDS Prevention, Centers for Disease Control and Prevention, Atlanta, GA.
Health Analytics, Research, and Reporting Department, Walgreen Co., Deerfield, IL.
出版信息
J Acquir Immune Defic Syndr. 2019 Nov 1;82(3):245-251. doi: 10.1097/QAI.0000000000002142.
BACKGROUND
A benchmark of near-perfect adherence (≥95%) to antiretroviral therapy (ART) is often cited as necessary for HIV viral suppression. However, given newer, more effective ART medications, the threshold for viral suppression may be lower. We estimated the minimum ART adherence level necessary to achieve viral suppression.
SETTINGS
The Patient-centered HIV Care Model demonstration project.
METHODS
Adherence to ART was calculated using the proportion of days covered measure for the 365-day period before each viral load test result, and grouped into 5 categories (<50%, 50% to <80%, 80% to <85%, 85% to <90%, and ≥90%). Binomial regression analyses were conducted to determine factors associated with viral suppression (HIV RNA <200 copies/mL); demographics, proportion of days covered category, and ART regimen type were explanatory variables. Generalized estimating equations with an exchangeable working correlation matrix accounted for correlation within subjects. In addition, probit regression models were used to estimate adherence levels required to achieve viral suppression in 90% of HIV viral load tests.
RESULTS
The adjusted odds of viral suppression did not differ between persons with an adherence level of 80% to <85% or 85% to <90% and those with an adherence level of ≥90%. In addition, the overall estimated adherence level necessary to achieve viral suppression in 90% of viral load tests was 82% and varied by regimen type; integrase inhibitor- and nonnucleoside reverse transcriptase inhibitor-based regimens achieved 90% viral suppression with adherence levels of 75% and 78%, respectively.
CONCLUSIONS
The ART adherence level necessary to reach HIV viral suppression may be lower than previously thought and may be regimen-dependent.
背景
通常认为，抗逆转录病毒疗法（ART）的近乎完美依从率（≥95%）是实现 HIV 病毒抑制所必需的。然而，鉴于新型、更有效的 ART 药物，病毒抑制的阈值可能更低。我们估计了实现病毒抑制所需的最低 ART 依从水平。
设置
以患者为中心的 HIV 护理模型示范项目。
方法
在每次病毒载量检测结果前的 365 天内，采用覆盖日比例法计算 ART 依从性，并将其分为 5 个类别（<50%、50%至<80%、80%至<85%、85%至<90%和≥90%）。采用二项回归分析确定与病毒抑制相关的因素（HIV RNA<200 拷贝/ml）；人口统计学、覆盖日比例类别和 ART 方案类型是解释变量。广义估计方程采用可交换工作相关矩阵，以考虑到个体内部的相关性。此外，还使用概率回归模型来估计实现 90%的 HIV 病毒载量检测抑制所需的依从水平。
结果
在依从水平为 80%至<85%或 85%至<90%的患者与依从水平≥90%的患者之间，病毒抑制的调整后比值比没有差异。此外，实现 90%的病毒载量检测抑制所需的总体估计依从水平为 82%，且因方案类型而异；基于整合酶抑制剂和非核苷类逆转录酶抑制剂的方案分别需要 75%和 78%的依从水平来实现 90%的病毒抑制。
结论
实现 HIV 病毒抑制所需的 ART 依从水平可能低于先前的设想，且可能取决于方案类型。
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