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Early adherence to antiretroviral medication as a predictor of long-term HIV virological suppression: five-year follow up of an observational cohort.

Ford N, Darder M, Spelman T, Maclean E, Mills E, Boulle A - PLoS ONE (2010)

Bottom Line: 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.Our 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.

View Article: PubMed Central - PubMed

Affiliation: Médecins Sans Frontières, Cape Town, South Africa. nathan.ford@joburg.msf.org

ABSTRACT

Objective: Previous 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.

Design: We 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.

Results: Our adherence cohort comprised 207 patients, among whom 72% were female. Median age was 30 years and median CD4 count at initiation was 55 cells/mm(3). 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.

Conclusions: Our 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.

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Cumulative hazard estimate for virological failure.
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pone-0010460-g001: Cumulative hazard estimate for virological failure.

Mentions: In our univariate analysis suboptimal early adherence was the only association with virological failure (hazard ratio 2.72, 95%CI 1.16–6.31, p = 0.02) (Table 2). In multivariate analysis we adjusted for baseline CD4 and age as these have been found to be associated with virological failure in larger studies from the same population [8]; this analysis 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 (95% CI 1.19–6.66, p = 0.018). Cumulative hazard estimates by adherence category are described in Figure 1.


Early adherence to antiretroviral medication as a predictor of long-term HIV virological suppression: five-year follow up of an observational cohort.

Ford N, Darder M, Spelman T, Maclean E, Mills E, Boulle A - PLoS ONE (2010)

Cumulative hazard estimate for virological failure.
© Copyright Policy
Related In: Results  -  Collection

Show All Figures
getmorefigures.php?uid=PMC2864744&req=5

pone-0010460-g001: Cumulative hazard estimate for virological failure.
Mentions: In our univariate analysis suboptimal early adherence was the only association with virological failure (hazard ratio 2.72, 95%CI 1.16–6.31, p = 0.02) (Table 2). In multivariate analysis we adjusted for baseline CD4 and age as these have been found to be associated with virological failure in larger studies from the same population [8]; this analysis 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 (95% CI 1.19–6.66, p = 0.018). Cumulative hazard estimates by adherence category are described in Figure 1.

Bottom Line: 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.Our 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.

View Article: PubMed Central - PubMed

Affiliation: Médecins Sans Frontières, Cape Town, South Africa. nathan.ford@joburg.msf.org

ABSTRACT

Objective: Previous 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.

Design: We 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.

Results: Our adherence cohort comprised 207 patients, among whom 72% were female. Median age was 30 years and median CD4 count at initiation was 55 cells/mm(3). 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.

Conclusions: Our 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.

Show MeSH
Related in: MedlinePlus