Antiretroviral medication adherence and class-specific resistance in a large prospective clinical trial

被引：50

作者：

Gardner, Edward M. ^{[1
]}

Hullsiek, Katherine H. ^{[2
]}

Telzak, Edward E. ^{[3
]}

Sharma, Shweta ^{[2
]}

Peng, Grace ^{[2
]}

Burman, William J. ^{[1
]}

MacArthur, Rodger D. ^{[4
]}

Chesney, Margaret ^{[5
]}

Friedland, Gerald ^{[6
]}

Mannheimer, Sharon B. ^{[7
]}

机构：

[1] Denver Publ Hlth, Denver, CO 80204 USA

[2] Univ Minnesota, Minneapolis, MN USA

[3] Bronx Lebanon Hosp Ctr, Bronx, NY 10456 USA

[4] Wayne State Univ, Detroit, MI USA

[5] Univ Maryland, Med Ctr, Baltimore, MD 21201 USA

[6] Yale Univ, Sch Med, New Haven, CT USA

[7] Columbia Univ, Coll Phys & Surg, Harlem Hosp, New York, NY USA

来源：

AIDS | 2010年 / 24卷 / 03期

基金：

美国国家卫生研究院;

关键词：

adherence; antiretroviral resistance; antiretroviral therapy; HIV; virological failure; REVERSE-TRANSCRIPTASE INHIBITORS; DRUG-RESISTANCE; PROTEASE INHIBITORS; VIRAL LOAD; THERAPY; NAIVE; MUTATIONS; AIDS; PROGRESSION; OUTCOMES;

D O I：

10.1097/QAD.0b013e328335cd8a

中图分类号：

R392 [医学免疫学]; Q939.91 [免疫学];

学科分类号：

100102 ;

摘要：

Objective: To assess the association between adherence to antiretroviral therapy and the presence of class-specific antiretroviral medication resistance. Design: Secondary analysis of prospective clinical trial data. Methods: Participants randomized to the protease inhibitor or nonnucleoside reverse transcriptase inhibitor (NNRTI) strategies of the Community Programs for Clinical Research on AIDS (CPCRA) Flexible Initial Retrovirus Suppressive Therapies (FIRST) Study were included. Adherence was measured by 7-day self-report. Virological failure was defined as an HIV-RNA more than 1000 at or after 4 months. The association between cumulative adherence and the development of class-specific genotypic resistance was assessed by Cox regression analysis. Results: Included were 457 and 446 antiretroviral-naive participants on the protease inhibitor and NNRTI strategies, respectively. The median time to initial virological failure in the protease inhibitor strategy was 1.2 years; 135 (30%) individuals failed with resistance. The median time to initial virological failure in the NNRTI strategy was 3.0 years; 127 (28%) failed with resistance. No association was found between cumulative adherence and protease inhibitor resistance [hazard ratio 1.1, 95% confidence interval (CI) 0.9-1.4 per 10% lower adherence]. However, lower cumulative adherence was associated with an increased risk of NNRTI resistance at initial virological failure (hazard ratio 1.2, 95% CI 1.1-1.3 per 10% lower adherence). in both strategies, lower cumulative adherence was associated with an increased risk of nucleoside reverse transcriptase inhibitor (NRTI) resistance at initial virological failure. Conclusion: Adherence-resistance relationships are class-specific. For NRTIs and NNRTIs, initial virological failure with resistance is more likely at lower levels of cumulative adherence. (C) 2010 Wolters Kluwer Health vertical bar Lippincott Williams & Wilkins

引用

页码：395 / 403

页数：9

共 26 条

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