Adherence to Drug-Refill Is a Useful Early Warning Indicator of Virologic and Immunologic Failure among HIV Patients on First-Line ART in South AfricaReportar como inadecuado




Adherence to Drug-Refill Is a Useful Early Warning Indicator of Virologic and Immunologic Failure among HIV Patients on First-Line ART in South Africa - Descarga este documento en PDF. Documentación en PDF para descargar gratis. Disponible también para leer online.

Background

Affordable strategies to prevent treatment failure on first-line regimens among HIV patients are essential for the long-term success of antiretroviral therapy ART in sub-Saharan Africa. WHO recommends using routinely collected data such as adherence to drug-refill visits as early warning indicators. We examined the association between adherence to drug-refill visits and long-term virologic and immunologic failure among non-nucleoside reverse transcriptase inhibitor NNRTI recipients in South Africa.

Methods

In 2008, 456 patients on NNRTI-based ART for a median of 44 months range 12–99 months; 1,510 person-years were enrolled in a retrospective cohort study in Soweto. Charts were reviewed for clinical characteristics before and during ART. Multivariable logistic regression and Kaplan-Meier survival analysis assessed associations with virologic two repeated VL>50 copies-ml and immunologic failure as defined by WHO.

Results

After a median of 15 months on ART, 19% n = 88 and 19% n = 87 had failed virologically and immunologically respectively. A cumulative adherence of <95% to drug-refill visits was significantly associated with both virologic and immunologic failure p<0.01. In the final multivariable model, risk factors for virologic failure were incomplete adherence OR 2.8, 95%CI 1.2–6.7, and previous exposure to single-dose nevirapine or any other antiretrovirals adj. OR 2.1, 95%CI 1.2–3.9, adjusted for age and sex. In Kaplan-Meier analysis, the virologic failure rate by month 48 was 19% vs. 37% among adherent and non-adherent patients respectively logrank p value = 0.02.

Conclusion

One in five failed virologically after a median of 15 months on ART. Adherence to drug-refill visits works as an early warning indicator for both virologic and immunologic failure.



Autor: Ziad El-Khatib , David Katzenstein, Gaetano Marrone, Fatima Laher, Lerato Mohapi, Max Petzold, Lynn Morris, Anna Mia Ekström

Fuente: http://plos.srce.hr/



DESCARGAR PDF




Documentos relacionados