血药浓度监测在儿童艾滋病患者抗病毒治疗依从性评价中的应用

The application of plasma drug monitoring in pediatric HIV/AIDS patient antiretroviral therapy adherence monitoring

目的 探讨血药浓度监测在儿童艾滋病患者抗病毒治疗依从性评价中的应用价值.方法 收集2009年3-10月河南省上蔡县CDC诊治的87例患儿连续3次随访的治疗相关信息及261份血浆标本,建立高效液相色谱-质谱联用的方法,测定血浆中抗病毒药物浓度.对治疗方案、患儿年龄、性别、父母情况、治疗经历和治疗时间等可能影响依从性的相关因素采用单因素Logistic回归分析.结果 以血药浓度是否低于LLTR 1000 ng/ml为标准判断患者是否漏服药物,发现28份标本血药浓度〈LLTR,这提示药物漏服.17例患儿在3次随访中至少1次血药浓度〈LLTR,占全部患儿的19.5%.在依从性影响因素的分析中发现,与父母均健在相比,父母中一方或双方均去世的患儿更容易出现药物漏服,比值比（OR）为4.13[95%可信区间（CI）：1.37～12.46,P值为0.012].结论 儿童艾滋病患者存在抗病毒治疗依从性问题,血药浓度监测可作为儿童依从性评价的有效手段之一.

Objective To evaluate the application of plasma drug monitoring in pediatric HIV/AIDS patient antiretroviral therapy adherence monitoring.Methods Totally 261 plasma samples and related information were collected from three consecutive follow-up visits of 87 HIV-infected children treated in Shangcai county CDC of Henan province from March to October 2009.The plasma concentrations of antiretroviral drugs were measured by a developed high performance liquid chromatography-mass spectrometry method.Potential adherence influencing factors, such as regimen, age, gender, parent conditions, previous ART exposure and therapy duration, were analyzed by univariate logistic regression.Results Plasma concentration of antiretroviral drugs lower than LLTR （1 000 ng/ml） was the criteria to identify missed dose.The concentrations of 28 plasma samples were lower than LLTR, which meant missing dose.There were 17 patients （19.5%） with their concentrations lower than LLTR at least once in three follow-up visits.Logistic regression analysis of adherence related factors showed that compared with the children whose parents were both alive, the children whose mother and （or） father died were more likely to miss dose.The odds ratio was 4.13（95% credibility interval：1.37-12.46, P values was 0.012）.Conclusions HIV-infected children have adherence problems when receiving antiretroviral therapy.Plasma therapeutic drug monitoring can be one of the effective methods to monitor the adherence.