Reduced adherence to antiretroviral therapy is associated with residual low-level viremia.

IF 2.3 Q2 MEDICINE, GENERAL & INTERNAL
Pragmatic and Observational Research Pub Date : 2017-05-26 eCollection Date: 2017-01-01 DOI:10.2147/POR.S127974
Franco Maggiolo, Elisa Di Filippo, Laura Comi, Annapaola Callegaro, Giorgio L Colombo, Sergio Di Matteo, Daniela Valsecchi, Marco Rizzi
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引用次数: 17

Abstract

The source and significance of residual low-level viremia (LLV) during combinational antiretroviral therapy (cART) remain a matter of controversy. It is unclear whether residual viremia depends on ongoing release of HIV from the latent reservoir or if viral replication contributes to LLV. We examined the relationship between adherence and LLV. Adherence was estimated by pharmacy refill and dichotomized as ≥95% or <95%. Plasma HIV-RNA was determined, with an ultrasensitive test having a limit of detection of 3 copies/mL at least 2 times over the follow-up period. Patients were grouped according to HIV-RNA over time as K<3: constantly <3 copies/mL; V<3: sometimes below or above the cutoff limit but always <50 copies/mL; K>3: constantly between 3 and 50 copies/mL; and V>50: a measure of >50 copies/mL minimum. Overall, 2789 patients were included. At each time point approximately 92% of the patients presented an HIV-RNA <50 copies/mL and two-thirds of those <3 copies/mL, 34.6% of patients had <3 copies/mL constantly, 32.7% sometimes below or above the cutoff limit but always <50 copies/mL, 9.5% constantly between 3 and 50 copies/mL, and 23.2% a measure of >50 copies/mL minimum. The mean adherence rate was 92.1% (95% confidence interval [CI] from 91.1% to 93.1%) in K<3 patients, similar in V<3 patients (91.9%), but lowered to 88.8% in K>3 patients and to 88.4% in V>50 patients (P<0.0001). Approximately 55% of patients in groups K<3 and V<3 showed an adherence rate ≥95%; this proportion lowered to ~51% in K>3 and to 48% in V>50. Moreover, 34% of patients with a steady adherence <95% were categorized as K>3, whereas 21.7% of those with a drug holiday (21.7%) were observed in the V>50 group (P=0.002). A steady viral suppression can occur despite moderate cART non-adherence, but reduced adherence is associated with low-level residual viremia, which could reflect new rounds of HIV replication. However, a detectable HIV-RNA could also be detected in patients with optimal cART adherence, indicating additional mechanisms favoring HIV persistence.

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抗逆转录病毒治疗依从性降低与残留的低水平病毒血症有关。
在联合抗逆转录病毒治疗(cART)期间残留低水平病毒血症(LLV)的来源和意义仍然是一个有争议的问题。目前尚不清楚残留病毒血症是否依赖于潜伏库中HIV的持续释放,或者病毒复制是否有助于LLV。我们检查了依从性与LLV之间的关系。通过补药来评估依从性,并将依从性分为≥95%或3:持续在3至50份/mL之间;V>50:最小值>50 copies/mL。总共纳入2789例患者。在每个时间点,大约92%的患者呈现至少50拷贝/mL的HIV-RNA。K3患者的平均依从率为92.1%(95%可信区间[CI]为91.1% ~ 93.1%),V>50患者的平均依从率为88.4% (P3), V>50患者的平均依从率为48%。此外,在V>50组中观察到34%的患者稳定依从3,而21.7%的患者有药物假期(21.7%)(P=0.002)。尽管cART有一定程度的不依从性,但稳定的病毒抑制可能发生,但依从性的降低与低水平残留病毒血症有关,这可能反映了新一轮的HIV复制。然而,在具有最佳cART依从性的患者中也可以检测到可检测的HIV- rna,这表明有利于HIV持续存在的其他机制。
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来源期刊
Pragmatic and Observational Research
Pragmatic and Observational Research MEDICINE, GENERAL & INTERNAL-
自引率
0.00%
发文量
11
期刊介绍: Pragmatic and Observational Research is an international, peer-reviewed, open-access journal that publishes data from studies designed to closely reflect medical interventions in real-world clinical practice, providing insights beyond classical randomized controlled trials (RCTs). While RCTs maximize internal validity for cause-and-effect relationships, they often represent only specific patient groups. This journal aims to complement such studies by providing data that better mirrors real-world patients and the usage of medicines, thus informing guidelines and enhancing the applicability of research findings across diverse patient populations encountered in everyday clinical practice.
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