High Current CD4+ T Cell Count Predicts Suboptimal Adherence to Antiretroviral Therapy

High levels of adherence to antiretroviral therapy (ART) are necessary for achieving and maintaining optimal virological suppression, as suboptimal adherence leads to therapy failure and disease progression. It is well known that adherence to ART predicts therapy response, but it is unclear whether clinical outcomes of ART predict adherence. To examine the predictive power of current CD4+ T cell count for adherence of HIV-infected individuals to ART, we performed a cross-sectional analysis of 133 Dutch HIV patients with electronically measured adherence. In a multivariate analysis adjusting for a number of sociodemographic and clinical variables, high current CD4+ T cell count (>660 cells/mm3) was most strongly associated with lower adherence to ART (assessed as a continuous variable) during a two-month period immediately following the measurements of variables (P = 0.008). The twice-per-day (versus once-per-day) dosing regimen was also significantly associated with lower adherence (P = 0.014). In a second multivariate analysis aimed at determining the predictors of suboptimal (+ T cell count was again the strongest independent predictor of suboptimal adherence to ART (P = 0.015), and the twice-per-day dosing regimen remained associated with suboptimal adherence (P = 0.025). The association between suboptimal adherence and virological suppression was significant in patients with high CD4+ T cell counts, but not in patients with low or intermediate CD4+ T cell counts (P = 0.036 and P = 0.52, respectively; P = 0.047 for comparison of the effects of adherence on virological suppression between patients with high vs. low or intermediate CD4+ T cell counts), suggesting that apart from promoting suboptimal adherence, high CD4+ T cell count also strengthens the effect of adherence on virological suppression. Therefore, sustained efforts to emphasize continued adherence are necessary, especially for patients with high CD4+ T cell counts.实现并维持最优病毒学抑制，需高度依从抗逆转录病毒治疗（antiretroviral therapy, ART），因为依从性不佳会导致治疗失败与疾病进展。众所周知，ART依从性可预测治疗应答，但尚不清楚ART的临床结局是否能预测治疗依从性。为探究当前CD4+T淋巴细胞计数对HIV感染者ART依从性的预测效能，我们对133例经电子方式监测依从性的荷兰HIV感染者开展了横断面分析。在校正了多项社会人口学与临床变量的多因素分析中，变量检测完成后即刻的两个月随访期内，较高的当前CD4+T淋巴细胞计数（＞660 cells/mm³）与更低的ART依从性（以连续变量形式进行评估）相关性最强（P=0.008）。每日两次（相较于每日一次）的给药方案同样与更低的依从性显著相关（P=0.014）。在第二项旨在明确ART依从性不佳预测因素的多因素分析中，当前CD4+T淋巴细胞计数再次成为ART依从性不佳最强的独立预测因素（P=0.015），而每日两次的给药方案仍与依从性不佳相关（P=0.025）。在CD4+T淋巴细胞计数较高的患者中，依从性不佳与病毒学抑制之间的关联具有统计学意义，但在CD4+T淋巴细胞计数较低或中等的患者中则无此关联（分别为P=0.036与P=0.52；高CD4+T淋巴细胞计数组与低/中等CD4+T淋巴细胞计数组之间，依从性对病毒学抑制的影响比较P=0.047），这表明除了会增加依从性不佳的风险外，较高的CD4+T淋巴细胞计数还会增强依从性对病毒学抑制的影响。因此，仍需持续强调坚持ART依从性，尤其针对CD4+T淋巴细胞计数较高的患者。