【Cochrane简语概要】如何查明艾滋病病毒感染者是否每天都在服药？

研究问题

对于艾滋病病毒感染者来说，每天服用艾滋病病毒药物（依从性）对于控制艾滋病病毒至关重要。衡量人们对艾滋病病毒药物依从性的最佳方法是使用“病毒载量测试”，它可以告诉我们血液中有多少病毒。病毒载量测试并非在任何地方都可用，例如在缺乏资金的地方。如果我们可以用更容易获得的测量方法来衡量依从性，这可能有助于发现在服药方面需要更多帮助的人。

（图片来自zjkc.cn）

本综述的目的

找出是否能通过简单的依从性测量方法告诉我们患者可能因为未能每天规律服药而导致更高的（可检测到的）病毒载量。额外的病毒载量监测可能会帮助这些人。这可以防止他们患上艾滋病病毒并发症或将艾滋病病毒传染给其他人。

我们发现了什么

我们找到了2003年至2021年间进行的51项包含感染艾滋病病毒的儿童和成人的研究。这些研究测试了测量依从性的不同方法，包括由患者填写的调查或评分表、对患者药片的计数、药房记录或小工具。

我们查看的所有措施都无助于找到可能未服用药物且病毒载量较高的患者。不同的研究显示了非常不同的结果。我们无法通过这些研究是否包括儿童或成人、他们是在富裕地区还是贫困地区、或者是他们过去常说的病毒载量高的界限来解释这些差异。这也意味着我们无法合并这些研究。

本综述的意义是什么？

根据结果，尚不确定是否可以通过简单的ART治疗依从性测量方法来帮助发现可能具有较高病毒载量的艾滋病病毒感染者。尽管如此，尝试测量依从性可能还有其他价值是本综述无法显示的。

报告证据的最新情况

证据更新至2021年4月22日。

作者结论: 

我们在所有指数测试中都遇到了高度差异性，并且所有领域的总体证据质量等级都极低。没有任何测量方法能始终如一地有足够高的敏感性或特异性来检测病毒的未抑制。这些问题限制了它们在对患者进行病毒载量监测或增强依从性支持干预方面的价值。

作者:Smith R, Villanueva G, Probyn K, Sguassero Y, Ford N, Orrell C, Cohen K, Chaplin M, Leeflang MMG, Hine P；译者：黄泽浩，Cochrane Hong Kong，香港中文大学医学院那打素护理学院；审校：牟焕玉，Cochrane Hong Kong，香港中文大学医学院那打素护理学院；编辑排版：索于思，北京中医药大学循证医学中心

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【Cochrane Plain Language Summary】

Are there good ways to find out if people living with HIV are taking their medicines every day?

The issue

For people with HIV, taking their HIV medicines every day (adherence), is vital to keep HIV under control. The best way to measure peoples’ adherence to HIV medicines is with ‘viral load testing’, which tells us how much virus there is in the blood. Viral load testing is not available everywhere, such as in places where there is lack of funds. If we could measure adherence with a more readily available measure, this might help detect people who need more help with taking their medicines.

Aim of this review

To find out if simple measures of adherence can tell us whether people might not be taking their medication every day and might then have higher (detectable) viral loads. These people might be helped by extra viral load monitoring. This could then prevent them developing complications from HIV or passing HIV to other people.

What we found

We looked at 51 studies involving children and adults with HIV that happened between 2003 and 2021. These studies tested different ways to measure adherence, including surveys or rating scales filled out by patients, counting of patients’ pills, pharmacy notes, or gadgets.

All the measures we looked at did not help find patients who might not be taking their medications and who had higher viral loads. Different studies showed very different results. We could not explain these differences by whether the studies included children or adults, whether they were in richer or poorer areas, or what cut off they used to say if the viral load was high. This also meant that we could not combine the studies.

What are the implications of this review?

Based on the results, it is uncertain that simple measures of adherence to ART treatment can help find people living with HIV who may have a higher viral load. Still, there may be other values to trying to measure adherence that this review cannot show.

Reporting how current the evidence is

The evidence is up-to-date to 22 April 2021.

Authors' conclusions: 

We encountered high variability for all index tests, and the overall certainty of evidence in all areas was very low. No measure consistently offered either a sufficiently high sensitivity or specificity to detect viral non-suppression. These concerns limit their value in triaging patients for viral load monitoring or enhanced adherence support interventions.

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