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首页> 外文期刊>AIDS Research and Human Retroviruses >Directly observed antiretroviral therapy in substance abusers receiving methadone maintenance therapy does not cause increased drug resistance.
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Directly observed antiretroviral therapy in substance abusers receiving methadone maintenance therapy does not cause increased drug resistance.

机译：在接受美沙酮维持疗法的药物滥用者中直接观察到的抗逆转录病毒疗法不会引起耐药性的增加。

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Direct observation of antiretroviral therapy (DOT) can increase adherence rates in HIV-infected substance users, but whether this affects the development of antiretroviral drug resistance has not been fully explored. We conducted a 24-week randomized controlled trial of methadone clinic-based antiretroviral DOT compared with treatment as usual (TAU) among antiretroviral-experienced substance users. To examine the development of new resistance mutations, we identified all participants with an amplifiable resistance test at both baseline and either week 8 or week 24. We compared the development of new drug resistance mutations between participants in the two arms of the trial. Among the 77 participants enrolled in the parent trial, antiretroviral DOT was efficacious for improving adherence and decreasing HIV viral load. Twenty-one participants had a detectable HIV viral load at both baseline and a second time point. Of these, nine developed new drug resistance mutations not seen at baseline (three in the DOT arm and six in the TAU arm; p = 0.27). Overall, five subjects in the TAU arm developed major mutations correlating with their current antiretroviral regimen, while no subjects in the DOT arm developed such mutations. Direct observation of antiretroviral therapy was associated with improved adherence and viral suppression among methadone maintained HIV-infected substance users, but was not associated with an increase in the development of antiretroviral drug resistance. DOT should be considered for substance users attending methadone maintenance clinics who are at high risk of nonadherence.
机译：直接观察抗逆转录病毒疗法（DOT）可以提高HIV感染物质使用者的依从率，但是尚未充分探讨这是否影响抗逆转录病毒药物耐药性的发展。我们对有经验的抗逆转录病毒药物使用者进行了美沙酮基于临床的抗逆转录病毒DOT与常规治疗（TAU）相比的24周随机对照试验。为了检查新的耐药性突变的发展，我们在基线以及第8周或第24周对所有参与者进行了可放大的耐药性测试。我们在试验的两个方面比较了参与者之间新的耐药性突变的发展。在参加该母试验的77名参与者中，抗逆转录病毒药物DOT可有效改善依从性并降低HIV病毒载量。 21名参与者在基线和第二个时间点都有可检测到的HIV病毒载量。其中，有九个出现了在基线时未见的新耐药性突变（DOT组三个，TAU组六个; p = 0.27）。总体而言，在TAU组中有5名受试者发生了与他们目前的抗逆转录病毒疗法相关的重大突变，而在DOT组中没有受试者发生这种突变。直接观察到抗逆转录病毒疗法与美沙酮维持的HIV感染者之间依从性的提高和病毒抑制的改善有关，但与抗逆转录病毒药物耐药性的发展没有关系。对于在美沙酮维持诊所就医的不遵守风险较高的药物使用者，应考虑使用DOT。

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