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Adherence | 26 .. 2008

....Դõ ǡԡԨ

Adherence

ҵҹʹ㹻Ѩغѹ ռŵͼµԴʹҧ ªԵŧ 纻Ŵŧ öѺԵ§Ѻ ҧá¢ŷ㹻Ѩغѹöشҵҹ еͧѺзҹʹ ѧ鹻ѨӤѭشзª ҡҵҹʤ Adherence еԴ ҧԴʹ 㹻էҳӡѴ

Ѱöҵҹ ʹӹǹҡ§ٵáҹ

¢ͧ Adherence ͡еԴ

դ 2 ӷѡѹ compliance adherence 㹡ѡҴҵҹʹѡ adherence ҡ compliance compliance ¶֧ ͿѧᾷлԺѵԵᾷ adherence 繤ӷٹҧѺеѴԹҨлԺѵԵ Ѻзҹ١Ҵ ١ҵᾷй šѡҴշش ѡеͧҵԴ仴 ֧еԴ ѧҡҵͧü¢ͧѺªҡҵҹʹҹش Դѭҡôҹ·ش Ǽµá ͹ҵҹ ੾С鹶֧Ӥѭͧ adherence

Adherence ֧դӤѭҡ͡ҵҹʹ

HIV դöԴô 觵Ǩӹǹѹ ͡ʡ¾ѹ٧㹡觵Ф ҡ㴡¡Թ ͡Թ§ҧ ʨա觵ǷѹоС¾ѹԴô§ ҵҹС ЪԴ͡Դôᵡҧѹ͡ 㹡 Non nucleoside reverse transcriptase inhibitor (NNRTI) ҷٵҵðҹѹѺá (NNRTI-based regimen) Ҩ nevirapine (NVP) efavirenz (EFV) ҷ͡ʴҧҡ §á¾ѹ§˹ (ҡ ˹觷) ͨдҷѹ 仡ҹҡҵ˹觡ѡд͢ѧա ѧ鹨֧öҵ㹡ǡѹա ·㹡 Nucleoside reverse transcriptase inhibitor (NRTI) ¹ѡ ͧա˹觡á¾ѹ ˹觷¡ Thymidine analogue mutation (TAM) nucleoside analogue mutation (NAM) NRTI ˹觷öҧǴ¡á¾ѹ˹Ǥ larmivudine (3TC) ҷդʹ٧Ţҧ§ ֧ѡǹ˹觢ͧٵҵðҹ GPV VIR-S (d4T + 3TC + NVP), GPO VIR-Z (AZT + 3TC + NVP), d4T + 3TC + EFV d4T + 3TC + IDV + RTVٵҷѹѺá NNRTI based regimen ҨҼǡѹ 3 Դ ٵôѧǨ 2 Դ͡ʴѹ ʹբͧٵùҡҤҶ١ (NVP based regimen) Ѻзҹдǡ§ 1 ѹ 2 (GPO VIR-S GPO VIR-Z) ¤ ô 㹡óշشѺзҹҾѹ NRTI back bone ж١Ѻ͡ҡҧ 24 half life (T½) 鹡Ҩ§ NNRTI 㹡ʹ ǡҡ ѡɳ蹹 ¡áԹ§Դ (monotherapy) 㹼¡Թ NVP single dose ͻͧѹõԴͨҡ١Фʹ ͡ʷԴô NVP ٧֧ 30-50%1 ҡ¡ѺѺзҹٵ֧ adherence ҧ ʢͧҨԴô NVP ֧СԹ 3 Դ͹ѺԹ§ 2 Դ ջԷҾ§ͷФǺ ѧ鹡Դô 3TC §ҡô ʹ͡ҡд͵ NNRTI 3TC Ǩա NAM ҡ樹͵㹡 NRTI ء ԸշշشͻͧѹԴ˵ءóѧ

µͧ adherence 㹡áԹҵҹʹ

Paterson Ф2 ӡ֡Ҥѹҧ adherence Сõͺʹͧ͡ѡҴҵҹ ¡Ѵҳʹѧѡ ҡ >400 copies/mL ҡѡ (virologic failure) Ѵ adherence ػóɷ¡ Medication Events Monitoring System (MEMS) 觵Դ駷ҢǴ ء駷աԴǴҨաúѹ֡ ѹ ҢͧԴǴ ͷҺҼ¹ҨԴǴѺзҹ աùѺӹǹҡԹúӹǹᾷ ҡ֡ҹ龺Ҽ· adherence ҡ 95% ҹ鹷 virologic failure ش 21.7 % 㹡óշ· adherence ŧ virologic failure ֧ adherence < 70% virologic failure ٧֧ 82.1 % ѧٻ 1. Ҽµͧ adherence ٧ҡ (>95%) ҹ鹨šѡҷ Ԩ¹֡㹼· protease inhibitor (PI)-based regimen 觵ͧѺзҹҨӹǹ¤˹ѹ ҨռŷõͺʹͧŴŧ ֡е3 ººҧ· NNRTI-based regimen Ѻ· PI-based regimen 㹼· adherence 㹡Ѻ NNRTI-based regimen virologic failure ¡ PI-based regimen ѧٻ 2. ҧáԨ¹龺Ҽ¨ٵ ҡ adherence շش õͺʹͧ͡ѡҡ٧ش ҡöѺзҹᾷ 100 % ʨж١Ǻա觵 Դô Ҩ֧ӤӤѭͧáԹ adherence ҡشҷ

ԸաѴ Adherence

· 4 Ը ԸբʹТͨӡѴ Ըá 駼ͧ Ѻзҹ Ըշѹ дǡǴ Ͷ

ǹ˭ѡŷԹԧ Ըշ 2 öԹҡ㹪ǧҷҹ 1 ѻҹ ѡШա繤 ѧ ҡŹЪѴ adherence 4 ҨԹ͹件֧ùѴ¤ǷǶ֧駹Թ仡 ѺùѺӹǹ ŷ§ç ҧáºҧ·դҨйҷ仵ӹǹѹѴ Ըշ 3 ͵ǨдѺʹ ö͡ҼѺзҹҨԧ㹪ǧ͹Ҿᾷ ͹ ٧ дǡ ѡ㹡Ԩ ֧͡ѹ͹˹ҨҾᾷ Ѻзҹ óշ»ʸشҳ٧ҡ 觼¹ҨѺзҹ Ըش«㹵ҧȤ MEMS բеͧ෤ ٧ СԴǴ¤ҼµͧѺзҹ

Ѩ·ռŵ adherence

Ѩѡռŵ adherence 4 Сä ջѨ´ҹ Ѩ¢ͧҵҹ Ѩ´ҹѹҧᾷ ˹ҷúԡáѺ лѨ´ҹкԡ

Ѩ´ҹ

֡㹵ҧ4 Ҽ·Դ ʾԴ ·зҧԵ ´عç ·ա֡ҵ ·Һҵҹúҧ

· self-efficacy (·ҵͧöлԺѵԵᾷ) м繻Ѩ§зеԴѺҵҹ 㹢з·ѺúӺѴҧԵ ·öѴѺзҹҡѺԨѹͧ ·ҡáԹҧͨзʹ зҺҧաҨеͧ觤Ѵ㹡áԹ١ТҴ ·öѺзҹҵҹʵ˹Ҽͧź͹4 м·ҵԴѡҧ6 繻Ѩ·ӹҼҹö adherence ֡㹵ҧ5 Ҽ¨ӹǹҡѡѺзҹúǹ١ͧᾷ Ͷ֧˵ؼ ǹ˭ѡеͺ ҹ觨 仵ҧѧѴ Ѻ仨Ѻзҹ ´Ы ռŢҧ§ͧ 纻´ҡ蹨֧ ѧ鹺ؤҡ÷ԡõͧ¼ºèѴ ҧἹáԹҢͧҡѺԵШѹ ҧա·ش ҡʺóԴһѨ´ҹ¢ͧ Ҩջѭҹ¡㹵ҧФѡþ Ͷᾷ ԺѵԵᾷա ҧáѨ·Ҩеͧ㹼 ء·Ҥ ͧ ҵҹʹó觴ǹ դ繵ͧҷѹ ҵҹ㹡þ¤á 㹻繵ҧ Ҽ¨öԺѵԵҵͧ

· ѺҺõԴ HIV ͧ з֡դسҷ駵͵ͧ

ͺ

· ѡҴҵҹʹ¨ҡä §Ǻҹ

зآҾ դسҾԵբ

- µͧԹҵʹԵժԵ׹ǵ

- áԹͨзʹ СѺä͡ա

· õͺʹͧҵҹٵáдշش ҡҨöٵ

ҧͧ Ҩеʹ (ҧҡԹ 3-5 աд ͧ

¹ٵ)

- ¢ͧѡ С¹ŧͧ CD4 дѺʷͧ

- ٵҷ͡ ԸաԹҧԴԷҾ٧ش

- Ըҷ㹡áԹҡѺԵШѹ Ѻзҹ

âͧ ػó Ѻ ԡ ѾͶ

ء͹ҷͧѺзҹ ҨԷҾ㹡áԹҢͧ

Ѩ´ҹҵҹ

Ѩ´ҹҵҹդӤѭǡѹШҡ֡Ҿ ӹǹҷͧѺзҹФ駷ըӹǹҡ ͧúҷ ҷբͨӡѴͧ ҷöӵԴ仴 (ͧ) ҷռŢҧ§٧ 繻Ѩ· adherence Ŵŧ6 ѧҷԵ͡ѧоŴͨӡѴҹŧ 蹻Ѩغѹٵҵҧ оҼ ӹǹŴŧҹŧ ռŢҧ§ҡѡ ҧáҡ֡Ҷ֧㹡ú7 դᵡҧҧúѹ 1 Ѻ ѹ 2

ѺҷԵͧѪѡٵáͧ¤ GPO VIR-S GPOVIR-Z ѺҵҹʷդسѵԤ͹ҧ ٵҼͧ 3 Դǡѹ Ѻзҹ§ 1 ѹ 2 բͨӡѴҹ öԴдǡ ջѭͧŢҧ§͹ҧ٧੾áͧҨҡ NVP Ţҧ§Ӥѭ ԴѺѺʺعçѹ ѧ㹡áԹҤáᾷͧ NVP ѹ 1 駡͹ 2 ѻ ͹Ңѹ 2 ҧͧ͸Ժ¼Ţҧ§ҨԴ Ţҧ§ҡ㴷ѹ 蹼蹷駵Ѻҡ 蹷յ ᴧ ҡѡʺ պشСѺᾷѹ ҡ㴷عçöʹҡѡѡҵҡ仡͹ ͧաõԴ÷ӧҹͧѺء 2 ѻ㹪ǧáյѺѡʺԴ 㹢з· EFV ͧҼǹ˭ ԴŢҧ§ǡѺкҷ ù͹Ѻ ѹ ԧ¹ҡ ҡҹѡԴ 1-2 ѻá Ѻзҹҡ͹͹ŴŢҧ§ ҡôѧǨФբ Ҽҹ ҺҧҨз ¹ ੾ IDV/r ѺзҹѧêŴҡôѧôٴ ·ҡä¹عçҺҡ ddI ҷͧѺзҹзͧҧ֧

ٴ ѧ鹤Ѻзҹ 1 ͹ 2 ѧ ͹ҵҹ

ᾷѪäêᨧͧáԹ㹢Ҵ ١ͧ Ѻзҹҵҹѹ 2 ҧѹ 12 ءѹ 08.00 . 20.00 . ǡѺ(ͧѺзҹѧ) ºҧҨдǡѺзҹ 12.00 . 24.00 .

Ţҧ§ǢͧҵҹʡҨռŵ adherence 蹡ѹ lipoatrophy ͺ ᢹպ dyslipidemia, peripheral neuropathy ҵ ѡԴҡ d4T աûѺ¹ٵռŢҧ§Ŵŧ ੾㹼·դѧ 蹾Ѻ մԷȹ ػó Ҩ adherence ¡êᨧŵҧ 駼Ţҧ§ҨԴ㹪ǧ㴺ҧ ԸաèѴáѺŢҧ§ Ţҧ§عçͧҾᾷ óթءԹоᾷ˹ҷ͵ԴТͤӻ֡ҧ

Ѩ´ҹѹͧᾷ˹ҷԡáѺ

ѹѹ Ͷҧ СѺѧѭ ҧԡмѺԡ繻ѨӤѭҧ˹觢ͧѺзҹҧ ǹͧԡ ͡ҡᾷ ͧշҹդʹ 㨷ѧ¨ ͼҧ ҹûСͺºؤҡôѧ

- Һӻ֡ 觨繼ҹͧäͧ ѡ ѧ繼Ѻѧѭ ͧ зԴ֧֡سҢͧͧ

- Ѫê͸Ժ ͧҷ١ͧ šè١ͧ Ѻ֡һѭǡѺ ͵Ǩͺ㹡ó drug-drug interaction

- ѡѧʧªͼ㹴ҹ ÷ӡԨѹ ѹҧ˹ҷ мҡ

˹ҷҹ Ѻͺҹӻ֡СôżµԴ͡͹÷ӧҹաͺդѹµʹҢͧûԺѵԧҹ͡ҡҧѹ ԡäաûԹ adherence ͧҧ ͧҡҼҹ adherence ͧѡФŴŧ 㹼·ջѵ adherence ҡ͹ й¡ treatment fatigue adherence waning8

Ѩ´ҹкԡ

Ҷ֧кԡ ҵҹ繻Ѩ·դӤѭ adherence9,10 ֡㹵ҧȾҼ·ջʺóաѺкԡ˹ҷԡù adherence 11 㹻¡ҵҹʹµԴ ç NAPHA Ѻç÷ʺҡç˹ öҶ֧ҵҹ¤ շԡ դ Ф㨨ҡؤҡ½ 觼ҹͺҧա͹Թ դԹԡкɷԡ öҶ֧ԡ§ ѧкԡ зԡ÷չҨ繵ẺͧҵҹʹçûСѹآҾǹ˹ ԴѭʹҨӹǹҡ㹼µԴ ö GPO VIR ա

ػ

ѡҼµԴʹҵҹʶ繤ҷ¢ͧԡҧҡ ͧҡҵҹö¹ԵʹҡͧءҹҡõԴͩ͡ Ҿҧ·شѺç 纻 դسҾԵմ ӧҹ öѺԵ§Ѻá ҡҹ˹ѡ֧Ӥѭͧ еԴ зԴʹԴ ¢ͨӡѴҹҳ駴ҹԹԨ¡ôٵҷйԴô ·еռšз٧ҡ Ҩе͵ǼͧҨСѺҾѡ ͷԴŷعçҡҡͷԴ ѧظշش͡ûͧѹ ¡÷ adherence ٧شء

References

1. Jourdian G, Ngo-Giang-Huang N, Le Coeur S, et al. Intrapartum exposure to nevirapine and subsequent maternal responses to nevirapine-based antiretroviral therapy. N Engl J Med 2004; 351:229-40.

2. Paterson DL, Swindells S, Mohr J, et al. Adherence to protease inhibitor therapy and outcomes in patients with HIV infection. Ann Intern Med 2000; 133:21-30.

3. Bangsburg D, Weiser S, Guzman D, Riley E. 95% adherence is not necessary for viral suppression to less than 400 copies/mL in the majority of individuals with NNRTI regimens. In: Program and abstracts of the 12th Conference on Retroviruses and Opportunistic infection. Boston, Massachusetts. (Abstract 616).

4. Cheever L. Forum for Collaborative HIV Research. What do we know about adherence levels in different populations? Adherence to HIV therapy: Building a bridge to success. Available at http://www.gwhealthpolicy.org. Washington, D.C. 1999:10.

5. Chesney MA. Factors affecting adherence to antiretroviral therapy. Clin Infect Dis 2000; 30 Suppl 2:S171-6.

6. Lucas GM, Chaisson RE, Moore RD. Highly active antiretroviral therapy in a large urban clinic: Risk factors for virologic failure and adverse drug reactions. Ann Intern Med 1999; 131:81-7.

7. Claxton AJ, Cramer J, Pierce C. A systematic review of the associations between dose regimens and medication compliance. Clin Ther 2001; 23:1296-1310.

8. Mannherheimer S, Friedland G, Matts J, et al. Self-reported antiretroviral adherence correlates with HIV viral load and declines over time. 13th International AIDS Conference. Durban, South Africa, 2000. (Abstract TuOrB421)


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