Impact of variability in adherence to HIV antiretroviral therapy on the immunovirological response and mortality

Boussari, Olayidé; Subtil, Fabien; Génolini, Christophe; Bastard, Mathieu; Iwaz, Jean; Fonton, Noël; Etard, Jean‐François; Écochard, René

doi:10.1186/1471-2288-15-10

Cited by 35 publications

(21 citation statements)

References 25 publications

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“…Respondents in the current study (44% (76)) were found to be non adherent to their prescribed cART (Figure 1). It must be emphasized that adherence to cART is critical for successful viral suppression because non adherence could lead to an increase in HIV viremia, risk of treatment failure, and accumulating resistance mutations [37]. The 44% non adherence rate is very alarming and Similar to the current study, in Thailand slightly higher (48.4%) suboptimal adherence to cART among adolescents was reported [24].…”

Section: Adherence To Cartsupporting

confidence: 67%

Factors Influencing Adherence to Antiretroviral Therapy among HIV Positive Adolescents at Adult Infectious Diseases Center in Lusaka, Zambia

Namoomba¹,

Makukula²,

Masumo³

2019

OJN

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Background: Non-adherence to combination antiretroviral therapy leads to drug resistance, treatment failure and increased morbidity and mortality among HIV positive adolescents. The aim of this study was to assess factors influencing adherence to combination antiretroviral therapy among HIV positive adolescents at Adult Infectious Disease Center in Lusaka, Zambia. Methodology: A descriptive quantitative cross sectional study was conducted on 173 adolescent respondents on antiretroviral therapy who were selected using a systematic random sampling method. Data was collected using the questionnaires with the adopted Morisky drug adherence scale and analyzed using Statistical Package for the Social Sciences software, version 20. Chi square, fishers' exact statistical tests and the binary logistic regression model were used to determine true predictors and to adjust confounders of adherence. The cut off point for statistical significance was set at 5%. Results: This study established that 76 (43.9%) of the respondents were non-adherent to their antiretroviral therapy. Knowledge of HIV and disease progression was reported to be low but had no statistical impact on antiretroviral therapy adherence. Stigmatization was high (99 (57.2%)) but did not significantly influence adherence to combination antiretroviral therapy on the study participants. Factors which were found to be statistically significant to adherence to therapy when a binary logistic regression was performed were experiencing side effects to therapy (p-value 0.047, odds ratio = 0.412); understanding reason for taking combination antiretroviral therapy (p-value 0.006, odds ratio = 5.978) and being reminded to take drugs (p-value 0.006, odds ratio = 0.505). Conclusion: The study found that there was high level of non-adherence to combination antiretroviral therapy which could subsequently lead to

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Section: Adherence To Cartsupporting

confidence: 67%

Factors Influencing Adherence to Antiretroviral Therapy among HIV Positive Adolescents at Adult Infectious Diseases Center in Lusaka, Zambia

Namoomba¹,

Makukula²,

Masumo³

2019

OJN

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“…Adolescents and young adults globally pose challenges to HIV treatment programs, particularly in LMICs where weak health systems, lack of support for adherence and retention and limited access to VL monitoring, contribute to VF. 26,27 While ART has been effective in decreasing AIDS-related deaths among adults, benefits among adolescents and younger adults have been limited. 21 In SSA, poor adherence and loss to CD4 count (cells/mm 3 follow-up among adolescents and young adults have been reported compared to older individuals living with HIV.…”

Section: Discussionmentioning

confidence: 99%

Drug Resistance Among Adolescents and Young Adults with Virologic Failure of First-Line Antiretroviral Therapy and Response to Second-Line Treatment

Kouamou

Varyani

Shamu³

et al. 2020

AIDS Research and Human Retroviruses

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Barriers to sustainable virologic suppression (VS) of HIV-infected adolescents and young adults include drug resistance mutations (DRMs) and limited treatment options, which may impact the outcome of second-line antiretroviral therapy (ART). We sequenced plasma viral RNA from 74 adolescents and young adults (16-24 years) failing first-line ART at Newlands Clinic, Zimbabwe between October 2015 and December 2016. We evaluated first-line nucleoside reverse transcriptase inhibitor (NRTI) susceptibility scores to first-and second-line regimens. Boosted protease inhibitor (bPI)-based ART was provided and viral load (VL) monitored for ‡48 weeks. Fisher's exact test was used to evaluate factors associated with VS on second-line regimens, defined as VL <1,000 copies/mL (VS 1,000 ) or <50 copies/mL (VS 50 ). The 74 participants on first-line ART had a median [interquartile range (IQR)] age of 18 (16-21) years and 42 (57%) were female. The mean (-standard deviation) duration on ART was 5.5 (-3.06) years and the median (IQR) log 10 VL was 4.26 (3.78-4.83) copies/mL. After switching to a second-line PI regimen, 88% suppressed to <1,000 copies/mL and 76% to <50 copies/mL at ‡48 weeks. A new NRTI was associated with increased VS 50 ( p = .031). These 74 adolescents and young adults failing first-line ART demonstrated high levels (97%) of DRMs, despite enhanced adherence counseling. Switching to new NRTIs in second-line improved VS. With the widespread adoption of generic dolutegravir, lamivudine and tenofovir combinations in Africa, genotyping to determine NRTI susceptibility, may be warranted.

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“…In general, research to date on medication non‐adherence has been disease‐specific, assessing the impact of suboptimal adherence on surrogate health outcomes such as blood pressure, cholesterol levels and biological response . As multimorbidity increases with age, a disease‐specific perspective may not be appropriate for older cohorts …”

Section: Introductionmentioning

confidence: 99%

“…8,9 In general, research to date on medication non-adherence has been disease-specific, assessing the impact of suboptimal adherence on surrogate health outcomes such as blood pressure, cholesterol levels and biological response. [10][11][12] As multimorbidity increases with age, a disease-specific perspective may not be appropriate for older cohorts. 13,14 In 2002, a meta-analysis of the influence of adherence on health outcomes concluded that adherent people were nearly 3 times more likely to experience a positive treatment outcome than non-adherent people.…”

Section: Introductionmentioning

confidence: 99%

The association between medication non‐adherence and adverse health outcomes in ageing populations: A systematic review and meta‐analysis

Walsh

Cahir

Tecklenborg

et al. 2019

Brit J Clinical Pharma

137

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Aims The aim of this systematic review and meta‐analysis was to synthesise the evidence relating to medication non‐adherence and its association with health outcomes in people aged ≥50 years. Methods Seven databases were searched up to February 2019 for observational studies that measured medication (non‐)adherence as a predictor of the following health outcomes in adults aged ≥50 years: healthcare utilisation (hospitalisation, emergency department visits, outpatient visits and general practitioner visits), mortality, adverse clinical events and quality of life. Screening and quality assessment using validated criteria were completed by 2 reviewers independently. Random effects models were used to generate pooled estimates of association using adjusted study results. The full methodological approach was published on PROSPERO (ID: CRD42017077264). Results Sixty‐six studies were identified for qualitative synthesis, with 11 of these studies eligible for meta‐analyses. A meta‐analysis including 3 studies measuring medication non‐adherence in adults aged ≥55 years showed a significant association with all‐cause hospitalisation (adjusted odds ratio 1.17, 95% confidence interval [CI] 1.12, 1.21). A meta‐analysis including 2 studies showed that medication non‐adherence was not significantly associated with an emergency department visit (adjusted odds ratio 1.05, 95% CI 0.90, 1.22). Good adherence was associated with a 21% reduction in long‐term mortality risk in comparison to medication non‐adherence (adjusted hazard ratio 0.79, 95% CI 0.63, 0.98). Conclusion Medication non‐adherence may be significantly associated with all‐cause hospitalisation and mortality in older people. Medication adherence should be monitored and addressed in this cohort to minimise hospitalisation, improve clinical outcomes and reduce healthcare costs.

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Impact of variability in adherence to HIV antiretroviral therapy on the immunovirological response and mortality

Cited by 35 publications

References 25 publications

Factors Influencing Adherence to Antiretroviral Therapy among HIV Positive Adolescents at Adult Infectious Diseases Center in Lusaka, Zambia

Factors Influencing Adherence to Antiretroviral Therapy among HIV Positive Adolescents at Adult Infectious Diseases Center in Lusaka, Zambia

Drug Resistance Among Adolescents and Young Adults with Virologic Failure of First-Line Antiretroviral Therapy and Response to Second-Line Treatment

The association between medication non‐adherence and adverse health outcomes in ageing populations: A systematic review and meta‐analysis

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