Adherence and clinical outcomes of HIV patients switching to a fixed-dose combination regimen

Abstract

Background: The efficacy of antiretroviral therapy (ART) is monitored using clinical markers such as viral load (VL) and CD4 counts. Adherence to ART has been associated with viral suppression and improved clinical outcomes.Objectives: To determine the relationship between adherence status with multiple-tablet regimens (MTR) and fixed-dose combination (FDC) regimens, to weight, CD4 count and VL of patients living with HIV.Method: An observational, descriptive study was conducted on a closed cohort of patients living with HIV and attending a primary health care clinic in Northern Cape in South Africa between 01 January 2013 and 31 December 2015. Patients were on an MTR and changed to an FDC regimen. Adherence was measured using the medicine possession ratio (MPR).Results: Statistically significant differences exist between the mean MPR of the 30-day (p = 0.0308) and 28-day supply (p 0.0001) of the MTR when compared to FDC regimen. No statistically significant differences could be found between adherence and clinical outcomes such as weight, CD4 count and VL for either MTR or FDC regimens. The suppressed VL values measured for MTR were n = 299 (89.25%) and n = 415 (93.05%) for FDC regimen.Conclusion: Adherence improved when patients were switched to FDC, but no statistically significant differences in clinical outcomes measured as weight, CD4 count and VL between adherence status and regimen type could be found.Contribution: This study contributes to much-needed information about ART adherence and clinical outcomes (such as weight, CD4 count and VL) of adult HIV-positive patients in a public healthcare clinic in the Northern Cape, South Africa.

Understanding the role of religious beliefs in adherence to antiretroviral therapy among Pentecostal Christians living with HIV in sub-Saharan Africa: a scoping review

“…Remarkable health benefits are being derived by PLHIV, public health, and healthcare providers from the use of ART in the control and management of HIV [6][7][8]. Clinical markers such as viral loads and CD4 lymphocyte counts are usually used to assess the clinical efficacy of ART in PLHIV [9]. PLHIV who optimally adhere to taking at least 95% of ART as prescribed are known to experience undetectable viral loads and high CD4 counts [6,8,10].…”

Demographic and clinical factors correlated with clinical outcomes among people with HIV treated by antiretroviral therapy: a retrospective cohort study

“…The risk of death for patients with a peak CD4 cell count < 100 cells/µL was 16 times higher than for patients with a peak CD4 cell count ≥ 500 cells/µL. Early and rapid ART initiation strategy based on CD4 count has been reported to contribute to the prevention of HIV transmission and reduce the risk of several clinical outcomes [25,26]. In PWH, CD4 cell count is one of the most important laboratory measures of immune function; when CD4 cell count drops below a certain level, PWH are at higher risk of immunodeficiency and are more susceptible to infections that can lead to advanced HIV disease (AHD) or death [27].…”