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首页> 外文期刊>AIDS care. >Self-reported non-adherence to ART and virological outcome in a multiclinic UK study.
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Self-reported non-adherence to ART and virological outcome in a multiclinic UK study.

机译：在多诊所的英国研究中自我报告不坚持抗病毒治疗和病毒学结果。

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Adherence is of fundamental importance to ART success. We examined the association of self-reported non-adherence with demographic factors, health and behaviour issues, and virological outcome, in a multi-clinic study. Seven hundred and seventy-eight HIV patients in five clinics in London and Brighton completed a questionnaire on adherence and HIV/health issues at baseline in 2005/6. For 486 subjects taking ART, non-adherence in the past week was defined as: (A)>or=1 dose missed or taken incorrectly (wrong time/circumstances); (B)>or=1 dose missed; (C)>or=2 doses missed. Questionnaire data were matched with routine treatment and virology data for consenting subjects (61.4%). We assessed four virological outcomes in 307 of 486 patients: (i) VL>50c/mL using latest VL at the questionnaire and excluding patients starting HAART<24 weeks ago; (ii) VL>50c/mL using the first VL from 6 to 12 months post-questionnaire; (iii) any VL>50c/mL from 6 to 12 months post-questionnaire; (iv) among patients with VL<50c/mL at questionnaire, time to first subsequent VL>50c/mL over two years follow up. Non-adherence was reported by 278 (57.2%), 102 (21.0%) and 49 (10.1%) of 486 patients, for definitions A, B and C, respectively. Non-adherence declined markedly with older age, and tended to be more commonly reported by Black patients, those born outside the UK, those with greater psychological symptoms and those with suicidal thoughts. There was a weaker association with physical symptoms and no association with gender/sexuality, education, unemployment, or risk behaviour (p>0.1). In logistic regression analyses, younger age, non-UK birth and psychological variables were independent predictors of non-adherence [e.g., for non-adherence B: odds ratios (95% CI) were 0.95 (0.92, 0.98) for every year older age; 1.6 (1.0, 2.5) for non-UK born; 2.3 (1.5, 3.7) for suicidal thoughts]. Non-adherence was associated with poorer virological outcome; the most consistent association was for definition C. Among 255 patients with VL<50c/mL at baseline, non-adherence definition C was independently associated with subsequent VL>50c/mL [adjusted hazard ratio (95% CI) 3.2 (1.5, 7.2)]. Non-UK birth and psychological symptoms predicted non-adherence, but the most striking association was with younger age. Age should be an important consideration in clinical strategies to minimise non-adherence and in decisions regarding ART initiation. A simple measure of non-adherence can identify patients at risk of poorer virological outcome.
机译：坚持对ART成功至关重要。在一项多诊所研究中，我们检查了自我报告的不依从性与人口统计学因素，健康和行为问题以及病毒学结果之间的关系。伦敦和布莱顿五个诊所的778名HIV患者在2005/6年度完成了关于依从性和HIV /健康问题的问卷调查。对于486名接受抗逆转录病毒治疗的受试者，过去一周的不依从定义为：（A）≥1剂量或错过或服用不正确（错误的时间/情况）; （B）>或= 1个剂量错过; （C）>或= 2次剂量错过。问卷数据与同意受试者的常规治疗和病毒学数据相匹配（61.4％）。我们评估了486例患者中的307例的四种病毒学结果：（i）在问卷中使用最新VL的VL> 50c / mL，不包括开始于HAART <24周的患者; （ii）在问卷调查后6到12个月使用第一个VL进行VL> 50c / mL; （iii）问卷调查后6至12个月内任何VL> 50c / mL; （iv）在问卷调查中VL <50c / mL的患者中，随访两年后首次达到VL> 50c / mL的时间。分别对A，B和C定义的486名患者中有278名（57.2％），102名（21.0％）和49名（10.1％）未坚持治疗。随着年龄的增长，不依从性明显下降，并且黑人患者，在英国以外出生的人，具有较大心理症状的人和具有自杀念头的人更常报告不依从性。与身体症状的关联较弱，而与性别/性，教育，失业或冒险行为无关（p> 0.1）。在逻辑回归分析中，年龄，非英国出生和心理变量是非依从性的独立预测因素（例如，对于非依从性B：比年龄更大的比值比（95％CI）为0.95（0.92，0.98） ;非英国出生者为1.6（1.0，2.5）; 2.3（1.5，3.7）的自杀念头]。不坚持将导致较差的病毒学结果。最一致的关联是定义C。在基线水平VL <50c / mL的255位患者中，不依从定义C与随后的VL> 50c / mL独立相关[调整后的危险比（95％CI）3.2（1.5，7.2 ）]。非英国出生和心理症状预示着不依从，但最明显的关联是年龄较小。在临床策略中应将年龄作为一个重要考虑因素，以最大程度地减少不依从性，并在有关ART起始的决策中。一种简单的不依从性措施可以识别出病毒学结果较差的患者。

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