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.

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 indicator...

Full description

Bibliographic Details
Main Authors: Ziad El-Khatib, David Katzenstein, Gaetano Marrone, Fatima Laher, Lerato Mohapi, Max Petzold, Lynn Morris, Anna Mia Ekström
Format: Article
Language:English
Published: Public Library of Science (PLoS) 2011-03-01
Series:PLoS ONE
Online Access:http://europepmc.org/articles/PMC3052314?pdf=render
id doaj-44c838c457db4cf9bcb628173d80171d
record_format Article
spelling doaj-44c838c457db4cf9bcb628173d80171d2020-11-25T01:46:39ZengPublic Library of Science (PLoS)PLoS ONE1932-62032011-03-0163e1751810.1371/journal.pone.0017518Adherence to drug-refill is a useful early warning indicator of virologic and immunologic failure among HIV patients on first-line ART in South Africa.Ziad El-KhatibZiad El-KhatibDavid KatzensteinGaetano MarroneFatima LaherLerato MohapiMax PetzoldLynn MorrisAnna Mia EkströmAffordable 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.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).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).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.http://europepmc.org/articles/PMC3052314?pdf=render
collection DOAJ
language English
format Article
sources DOAJ
author Ziad El-Khatib
Ziad El-Khatib
David Katzenstein
Gaetano Marrone
Fatima Laher
Lerato Mohapi
Max Petzold
Lynn Morris
Anna Mia Ekström
spellingShingle Ziad El-Khatib
Ziad El-Khatib
David Katzenstein
Gaetano Marrone
Fatima Laher
Lerato Mohapi
Max Petzold
Lynn Morris
Anna Mia Ekström
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.
PLoS ONE
author_facet Ziad El-Khatib
Ziad El-Khatib
David Katzenstein
Gaetano Marrone
Fatima Laher
Lerato Mohapi
Max Petzold
Lynn Morris
Anna Mia Ekström
author_sort Ziad El-Khatib
title 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.
title_short 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.
title_full 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.
title_fullStr 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.
title_full_unstemmed 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.
title_sort 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.
publisher Public Library of Science (PLoS)
series PLoS ONE
issn 1932-6203
publishDate 2011-03-01
description 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.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).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).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.
url http://europepmc.org/articles/PMC3052314?pdf=render
work_keys_str_mv AT ziadelkhatib adherencetodrugrefillisausefulearlywarningindicatorofvirologicandimmunologicfailureamonghivpatientsonfirstlineartinsouthafrica
AT ziadelkhatib adherencetodrugrefillisausefulearlywarningindicatorofvirologicandimmunologicfailureamonghivpatientsonfirstlineartinsouthafrica
AT davidkatzenstein adherencetodrugrefillisausefulearlywarningindicatorofvirologicandimmunologicfailureamonghivpatientsonfirstlineartinsouthafrica
AT gaetanomarrone adherencetodrugrefillisausefulearlywarningindicatorofvirologicandimmunologicfailureamonghivpatientsonfirstlineartinsouthafrica
AT fatimalaher adherencetodrugrefillisausefulearlywarningindicatorofvirologicandimmunologicfailureamonghivpatientsonfirstlineartinsouthafrica
AT leratomohapi adherencetodrugrefillisausefulearlywarningindicatorofvirologicandimmunologicfailureamonghivpatientsonfirstlineartinsouthafrica
AT maxpetzold adherencetodrugrefillisausefulearlywarningindicatorofvirologicandimmunologicfailureamonghivpatientsonfirstlineartinsouthafrica
AT lynnmorris adherencetodrugrefillisausefulearlywarningindicatorofvirologicandimmunologicfailureamonghivpatientsonfirstlineartinsouthafrica
AT annamiaekstrom adherencetodrugrefillisausefulearlywarningindicatorofvirologicandimmunologicfailureamonghivpatientsonfirstlineartinsouthafrica
_version_ 1725018083740876800