Abstract
ObjectivePrevious studies have demonstrated a cross-sectional relationship between antiretroviral adherence and HIV virological suppression. We assessed the predictive value of baseline adherence in determining long-term virological failure.DesignWe assessed baseline adherence via an adherence questionnaire between administered to all consenting patients attending antiretroviral clinics in Khayelitsha township, South Africa, between May 2002 and March 2004. Virological status was ascertained after five years of follow up and multivariate analysis used to model associations of baseline variables and medication adherence with time to viral suppression or failure.ResultsOur adherence cohort comprised 207 patients, among whom 72% were female. Median age was 30 years and median CD4 count at initiation was 55 cells/mm3. We found no statistically significant differences between baseline characteristics and early adherence groups. Multivariate analysis adjusting for baseline CD4 and age found that patients with suboptimal baseline adherence had a hazard ratio of 2.82 (95% CI 1.19–6.66, p = 0.018) for progression to virological failure compared to those whose baseline adherence was considered optimal.ConclusionsOur longitudinal study provides further confirmation of adherence as a primary determinant of subsequent confirmed virological failure, and serves as a reminder of the importance of initial early investments in adherence counseling and support as an effective way to maximize long-term treatment success.
Highlights
The widespread availability of antiretroviral therapy (ART) has changed the course of HIV infection in developed countries, and comparable benefits are observed in resource-limited settings
Multivariate analysis adjusting for baseline CD4 and age found that patients with suboptimal baseline adherence had a hazard ratio of 2.82 for progression to virological failure compared to those whose baseline adherence was considered optimal
Virological failure may result from suboptimal adherence, poor drug potency, drug resistance, or a combination of these factors [3]
Summary
The widespread availability of antiretroviral therapy (ART) has changed the course of HIV infection in developed countries, and comparable benefits are observed in resource-limited settings. Virological failure may result from suboptimal adherence, poor drug potency, drug resistance, or a combination of these factors [3] Amid these multiple explanations, sub-optimal adherence to medication has been recognized as one of the main patient-mediated risk factors for treatment failure [3] and several studies have demonstrated a cross-sectional relationship between adherence and virological suppression [4,5,6,7]. Sub-optimal adherence to medication has been recognized as one of the main patient-mediated risk factors for treatment failure [3] and several studies have demonstrated a cross-sectional relationship between adherence and virological suppression [4,5,6,7] It is unknown whether patientmediated factors may predict poor adherence, and poor virological suppression, in the long-term. We aimed to assess this relationship in a longtitudinal study to determine the predictive value of baseline adherence in determining virological failure over time
Sign-in/Register to view highlights & summary 
Published Version (
Free)
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a call