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The association between combination antiretroviral adherence and AIDS-defining conditions at HIV diagnosis

机译：HIV诊断中抗逆转录病毒依从性与定义艾滋病的条件之间的关联

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Combination antiretroviral therapy (cART) has changed the clinical course of HIV. AIDS-defining conditions (ADC) are suggestive of severe or advanced disease and are a leading cause of HIV-related hospitalizations and death among people living with HIV/AIDS (PLWHA) in the USA. Optimal adherence to cART can mitigate the impact of ADC and disease severity on the health and survivability of PLWHA. The objective of this study was to evaluate the association between ADC at HIV diagnosis and optimal adherence among PLWHA. Using data from the 2008 and 2009 Medicaid data from 29 states, we identified individuals, between 18 and 49 years, recently infected with HIV and with a cART prescription. Frequencies and descriptive statistics were conducted to characterize sample. Univariate and multivariable Poisson regression analyses were employed to evaluate the association optimal cART adherence (defined as95% study days covered by cART) and ADC at HIV diagnosis (1 ADC) were assessed. Approximately 17% of respondents with ADC at HIV diagnosis reported optimal cART adherence. After adjusting for covariates, respondents with an ADC at HIV diagnosis were less likely to report optimal cART adherence (adjusted prevalence ratio (APR)=0.64, 95% confidence intervals (CI), 0.54-0.75). Among the covariates, males (APR=1.10, 95% CI, 1.02-1.19) compared to females were significantly more likely to report optimal adherence while younger respondents, 18-29 years (APR=0.67, 95% CI, 0.57-0.77), 30-39 years (APR=0.86, 95% CI, 0.79-0.95) compared to older respondents were significantly less likely to report optimal adherence. PLWHA with ADC at HIV diagnosis are at risk of suboptimal cART adherence. Multiple adherence strategies that include healthcare providers, case managers, and peer navigators should be utilized to improve cART adherence and optimize health outcomes among PLWHA with ADC at HIV diagnosis. Targeted adherence programs and services are required to address suboptimal adherence in this population.
机译：联合抗逆转录病毒疗法（cART）改变了HIV的临床过程。定义艾滋病的条件（ADC）提示严重或晚期疾病，并且是美国艾滋病毒/艾滋病患者（PLWHA）中与艾滋病有关的住院和死亡的主要原因。对cART的最佳依从性可以减轻ADC和疾病严重性对PLWHA的健康和生存能力的影响。这项研究的目的是评估HIV诊断ADC与PLWHA最佳依从性之间的关联。使用来自29个州的2008年和2009年医疗补助数据，我们确定了18至49岁之间最近感染了艾滋病毒并使用了cART处方的个人。进行频率和描述性统计以表征样品。采用单变量和多变量Poisson回归分析来评估最佳cART依从性（定义为95％的cART研究天数）的关联，并评估HIV诊断时的ADC（1 ADC）。约有17％的接受过HIV诊断的ADC的受访者表示最佳的cART依从性。校正协变量后，HIV诊断为ADC的应答者不太可能报告最佳的cART依从性（校正后患病率（APR）= 0.64，95％置信区间（CI），0.54-0.75）。在协变量中，男性（APR = 1.10，95％CI，1.02-1.19）与女性相比，更有可能报告最佳依从性，而年轻受访者则为18-29岁（APR = 0.67，95％CI，0.57-0.77） ，30-39岁（APR = 0.86、95％CI，0.79-0.95）相比，老年受访者报告最佳依从性的可能性显着降低。在HIV诊断中使用ADC的PLWHA可能无法达到最佳的cART依从性。应当采用包括医疗保健提供者，病例管理员和同行导航员在内的多种依从策略，以提高cART依从性，并在ADC诊断HIV的PLWHA中优化健康结果。需要针对性的依从性计划和服务来解决该人群中的次优依从性。

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