The association between adherence to antiretroviral therapy and viral suppression under dolutegravir-based regimens: an observational cohort study from Uganda

IF 4.6 1区医学 Q2 IMMUNOLOGY

Journal of the International AIDS Society Pub Date : 2024-08-18 DOI:10.1002/jia2.26350

Zachary Wagner, Zetianyu Wang, Chad Stecher, Yvonne Karamagi, Mary Odiit, Jessica E. Haberer, Sebastian Linnemayr

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引用次数: 0

Abstract

Introduction

Millions of people living with HIV (PLWH) take oral antiretroviral therapy (ART), which requires a lifetime of consistent medication adherence. The relationship between adherence and poor HIV outcomes is well documented. Newer ART regimens that include dolutegravir (DTG) could be more forgiving, but empirical evidence on the relationship between adherence and viral suppression under DTG is only emerging.

Methods

In this observational cohort study (secondary analysis of data from a randomized trial), we used data from 313 ART clients from a large HIV clinic in Kampala, Uganda. Over the 4-year study period (January 2018–January 2022), 91% switched from non-DTG regimens to DTG regimens. We measured adherence using Medication Event Monitoring Systems-caps and extracted prescription information and viral load measures from electronic health records. We estimated unadjusted linear regressions and adjusted models that included individual and time fixed-effects.

Results

Under non-DTG regimens, 96% of participants were virally suppressed (defined as viral load < 200 copies/ml) when adherence was 90% or higher in the 3 months before viral load measurement. Viral suppression was 32 percentage points lower when adherence was between 0% and 49% (95% CI −0.44, −0.20, p < 0.01), 12 percentage points lower when adherence was between 50% and 79% (95% CI −0.23, −0.02, p < 0.01), and not significantly different when adherence was between 80% and 89% (effect of 0.00, 95% CI −0.06, 0.07, p = 0.81). In contrast, for participants taking DTG, there was no statistically significant difference in viral suppression among any of the four adherence levels; more than 95% were virally suppressed at each adherence level. On average, switching to DTG increased viral suppression by 6 percentage points in our adjusted models (95% CI 0.00, 0.13, p = 0.03).

Conclusions

There was no significant association between adherence levels and viral suppression among PLWH taking DTG regimens, suggesting a high degree of forgiveness for missed doses. The use of DTG should be prioritized over older regimens, particularly for those with low adherence.

Clinical Trial Number

NCT03494777.

Abstract Image

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坚持抗逆转录病毒疗法与多鲁特韦治疗方案下的病毒抑制之间的关系：乌干达的一项观察性队列研究。

导言：数百万艾滋病病毒感染者（PLWH）接受口服抗逆转录病毒疗法（ART），这需要终生坚持用药。坚持用药与艾滋病治疗效果不佳之间的关系有据可查。包括多罗替拉韦（DTG）在内的新型抗逆转录病毒疗法可能更加宽松，但在 DTG 治疗下，依从性与病毒抑制之间关系的实证证据才刚刚出现：在这项观察性队列研究（对随机试验数据的二次分析）中，我们使用了乌干达坎帕拉一家大型艾滋病诊所的 313 名抗逆转录病毒疗法患者的数据。在为期 4 年的研究期间（2018 年 1 月至 2022 年 1 月），91% 的患者从非 DTG 方案转为 DTG 方案。我们使用用药事件监测系统（Medication Event Monitoring Systems-caps）测量了依从性，并从电子健康记录中提取了处方信息和病毒载量指标。我们估算了未经调整的线性回归结果以及包含个体和时间固定效应的调整模型：在非 DTG 方案下，如果病毒载量测量前 3 个月的依从性达到或超过 90%，则 96% 的参与者病毒得到抑制（病毒载量定义为小于 200 拷贝/毫升）。当依从性在 0% 到 49% 之间时，病毒抑制率降低 32 个百分点（95% CI -0.44，-0.20，p < 0.01）；当依从性在 50% 到 79% 之间时，病毒抑制率降低 12 个百分点（95% CI -0.23，-0.02，p < 0.01）；当依从性在 80% 到 89% 之间时，病毒抑制率无显著差异（效应为 0.00，95% CI -0.06，0.07，p = 0.81）。相比之下，对于服用 DTG 的参与者来说，四种依从性水平的病毒抑制率在统计学上都没有显著差异；在每种依从性水平上，都有超过 95% 的人得到了病毒抑制。在我们的调整模型中，改用 DTG 平均可使病毒抑制率提高 6 个百分点（95% CI 0.00, 0.13, p = 0.03）：结论：在服用 DTG 方案的 PLWH 中，依从性水平与病毒抑制率之间没有明显联系，这表明漏服剂量的容错率很高。应优先使用DTG，而不是旧的治疗方案，特别是对于依从性较低的患者：临床试验编号：NCT03494777。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Journal of the International AIDS Society IMMUNOLOGY-INFECTIOUS DISEASES

CiteScore

8.60

自引率

10.00%

发文量

186

审稿时长

>12 weeks

期刊介绍： The Journal of the International AIDS Society (JIAS) is a peer-reviewed and Open Access journal for the generation and dissemination of evidence from a wide range of disciplines: basic and biomedical sciences; behavioural sciences; epidemiology; clinical sciences; health economics and health policy; operations research and implementation sciences; and social sciences and humanities. Submission of HIV research carried out in low- and middle-income countries is strongly encouraged.

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