HAART??????? ?????? ???

1
HAART????????????????
HIV/AIDS????
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• ????????????????,?????????????,?????????,
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• HIV???????,????,????
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11
HAART??????????

• HIV????????
• ????????????????????
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12
Directly Observed Therapy (DOT) vs
Self-Administered Therapy (SAT)
DOT
100
90
80
70
60
50
Patients lt400 copies/mL,
40
30
20
10
0
0
4
8
16
32
48
64
72
80
88
Week
3 drug regimen that included efavirenz
statistically equivalent to DOT, 94 vs. 100
lt400 copies/mL
Fischl, et al. Abst. 528, 8th CROI, 2001.
13
What is Your Preferred Schedule For Taking HIV
Medications?
AWARE Poll Treatment Lifestyle Survey Responses
N 280
100
4 pills once during the day (either morning or
evening)
80
73
1 pill in the morning and2 pills at night
60
1 pill in the morning and4 pills at night
40
18
20
9
0
Regimen Characteristics
The AWARE Talk Radio Poll 2001-2002 The AIDS
Talk Radio Project in conjunction with The Core
Center AIDS Research Alliance Howard Brown
Health Center Chicago.
14
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• Data from the IDV era demonstrates the
  impact of even minor variations in adherence
• ?95 adherence is required for optimal
  virologic suppression

100
81
P .00001
75
64
Patients Reaching Undetectable HIV RNA LOQ 400
()
50
50
25
25
6
0
gt95
90-95
80-90
70-80
lt70
Greatest danger zone for developing resistance
1Paterson. Ann Intern Med 200013321.
15
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100
??????? ??95???? ????????
82
75
71
67
55
??????????
50
25
22
0
? 95
90-94.9
80-89.9
70-79.9
lt70
???,
MEMS Medication Events Monitoring
System Paterson DL et al. Ann Intern Med
20001332130.
17
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ART ????
100
80
????????
60
40
20
0
0
1
2
3
4
5
6
7
8
9
10
11
12
Month
18
????????????
???????? (N536)
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?????????HAART???????
100
?????
80
plt0.001
2
80
plt0.001
63
???????
25
60
??
???????
????
40
20
73
0
????
????
Bass D et al. XIV International AIDS Conference
2002, Barcelona, Spain. Poster MoPeB3290.
19
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3
5
24
68
plt0.001
????,??4?(????)
????,????
????,????
????
Bass D et al. XIV International AIDS Conference
2002, Barcelona, Spain. Poster MoPeB3290.
20
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21
???????????
100
?? (59)
???? (17)
90
80
?????? (36)
???? (15)
???? (13)
70
?? (26)
60
50
?? (16)
Headache (26)
???? (14)
?? (11)
40
30
?? (0)
20
??s (0)
10
0
POZ, vol 6 no. 2 May, 1998
22
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?????????efavirenz?HAART???????
100
80
95
96
60
??
40
20
0
??? 48 ? (n72/75)
???? 15 ?? (n36/38)
Based on the drop-out rate in the Bergamo
Study. Total dropouts (all causes) 15/75.
23
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• ??NRTISEFV?saquinavir/ ritonavir?? ???????
• ???EFV??????

24
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• ?????????3257????????????????????????2? NRTI ??
  ?? PI??? NNRTI ????? NRTI ? ??????????????????????
  ???25 ?????????23?????,31??????,??19???????????
• ????
• ????????????????????? (HIV RNA lt50 copies/ml
  p0.0085)
• ????????,???????????25

25
????????????
90
(r-0.57 p0.0085)
80
70
60
50
48??HIV RNA ?50??????
40
30
PI NRTI NNRTI
20
10
??????????????????
0
5
10
15
20
?????????
Bartlett JA et al. AIDS 20011513691377.
26
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• ?????????????????????????,?????ART???????????????
  ??,???????????????????????????,???????????????????
  ????,???????????

27
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• ????HAART??????
• ?????????????????????????????ART????????????????,
  ???????????????,???????,????,????,???????????ART??
  ?,????????????

28

• ?????????,????????,?????????,?????????????????????
  ??,??????????????????????????,?????????????ART????
  ?DOT???,??????????,??????????????????????,????????
  ??

29
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• ??
• ??

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• ??IDU
• ??

???????

• ??????
• ???????

• ??HAART
• ???????

Gebo. Abstract 477. Ostrow. 8th CROI 2001
Chicago. Abstract 484.
30
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????????????????2?????????????????
31
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• ?????????????????
• ?????????
• ??????????????
• ???????????????
• ???????????????
• Brushing teeth
• Eating a meal
• Watching the news
• Walking the dog

32
Enhancing AdherenceGet Support

• DOT directly observed therapy
• MOT mother observed therapy
• SOT sister, spouse observed therapy
• FOT father, friend observed therapy

33
Enhancing AdherenceListen to Your Patient

• Any complaint This is the reason I may not
  take my medication the way I should.
• Strategies for dealing with side effects
• Encourage the patient to continue if the side
  effect is temporary (punt)
• Replace medications if symptoms are persistent