Predictors of HIV Drug‐Resistance Mutations in a Large Antiretroviral‐Naive Cohort Initiating Triple Antiretroviral Therapy

Harrigan, P. Richard; Hogg, Robert S.; Dong, Winnie; Yip, Benita; Wynhoven, Brian; Woodward, Justin; Brumme, Chanson J.; Brumme, Zabrina L.; Mo, Theresa; Alexander, Chris; Montaner, Julio S. G.

doi:10.1086/427192

Cited by 376 publications

(316 citation statements)

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“…Most studies report that 40-60% of patients are less than 90% adherent to HAART. 13 Suboptimal levels of adherence result in fewer clinical benefits in terms of immunological and virological variables and contribute to the development of antiretroviral resistance 14,15 and higher mortality. 16,17 Whether a patient is adherent to their medications appears to be influenced by a range of medical and social determinants such as regimen complexity, patient-related factors, psychosocial issues, patient belief systems, and patient-provider relationship.…”

Section: Introductionmentioning

confidence: 99%

Nonadherence Increases the Risk of Hospitalization Among HIV-Infected Antiretroviral Naïve Patients Started on HAART

Fielden

Rusch

Yip

et al. 2008

Journal of the International Association of Physicians in AIDS

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Background. Since the advent of highly active antiretroviral therapy (HAART), AIDS-related hospitalizations have decreased. The objective of this study was to assess the impact of adherence on hospitalization among antiretroviral-naïve HIV-infected persons initiating HAART. Methods. Analysis was based on a cohort of individuals initiating HAART between 1996 and 2001. The primary outcome was hospitalization for one or more days. Survival methods were used to assess the impact of adherence on hospitalization. Results. Of 1605 eligible participants, 672 (42%) were hospitalized for one or more days after initiating HAART. Median adherence levels were 92 (IQR: 58, 100) and 100 (IQR: 83, 100) among those ever and never hospitalized, respectively. After controlling for confounders, those with <95% adherence had 1.88 times (95% CI: 1.60, 2.21) higher risk for hospitalization. Conclusions. Suboptimal adherence among HIV-infected patients taking HAART predicts hospitalization. Identifying and addressing factors contributing to poor adherence early in treatment could improve patient care and lower hospitalization costs.

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Section: Introductionmentioning

confidence: 99%

Nonadherence Increases the Risk of Hospitalization Among HIV-Infected Antiretroviral Naïve Patients Started on HAART

Fielden

Rusch

Yip

et al. 2008

Journal of the International Association of Physicians in AIDS

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“…Adherence has been described as the 'Achilles heel' of treatment success Chesney, 2003;McPherson-Baker et al, 2005). Partial or poor adherence can lead to a rebound in viral replication, poorer survival rates and the mutation to treatment-resistant strains of HIV (Alberdi Leniz et al, 2004;Harrigan et al, 2005). Writing prescriptions is easy but in the end, regardless of what the physician wants, the patient makes the ultimate decision whether or not to take ART.…”

Section: Introductionmentioning

confidence: 99%

To tell or not to tell: Why people with HIV share or don't share with their physicians whether they are taking their medications as prescribed

Kremer

Ironson

2006

AIDS Care

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This qualitative study examines whether HIV-positive people (N = 79) tell their physicians whether they take antiretroviral treatment (ART) as prescribed and why. Interviews, analyzed with qualitative content-analysis, asked about taking/not taking ART and, if taking, whether they shared their reasons for non-adherence with their physician. Patients are more likely to inform physicians why they take than why they do not take ART (p < 0.01). Only half of those not taking ART shared the reasons for their decision with their physician. The six motives were: anticipation that physicians will not support the decision, cannot discuss feelings, lack of trust in physician's opinion, unable to discuss spiritual/ moral issues, no need for physician to know, and not seen physician yet. Of those taking ART, 21% did not tell their physician why they missed doses. The five motives were: not viewed as important, physician not asking, not seen physician yet, rarely non-adherent, no indications in surrogate markers. A significant proportion of patients are not taking their medications as prescribed and are not telling their physicians. To facilitate the chance that patients communicate with their physicians, physicians need to ask and, while giving the patients medical information, create a non-judgmental, respectful atmosphere where patients feel comfortable sharing their personal view.

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“…Drug combinations are commonly used for chemotherapeutic indications in human medicine, including cancer as well as viral, bacterial and protozoan parasitic infections (White, 1999;Miles et al, 2002;Anonymous, 2004;Harrigan et al, 2005;Lane, 2006;Airley, 2009;World Health Organization, 2009;Bang, 2010;Hastings, 2011). The principle that combinations of chemotherapeutic agents benefit patients by maintaining drug efficacy in the presence of resistance has been repeatedly demonstrated in this context for diverse pathogens and builds on knowledge gained from insecticide, pesticide and herbicide use (Wood and Mani, 1981;Curtis, 1985;Mani, 1985;Comins, 1986;Diggle et al, 2003).…”

Section: Combining Anthelmintics: Current Situationmentioning

confidence: 99%

World Association for the Advancement of Veterinary Parasitology (W.A.A.V.P.) Guideline: Anthelmintic combination products targeting nematode infections of ruminants and horses

Geary

Hosking

Skuce

et al. 2012

Veterinary Parasitology

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a b s t r a c tIncreasing threats from anthelmintic resistant nematode populations warrant and motivate a reappraisal of chemotherapeutic strategies for nematode control in ruminant livestock and horses. The objective of this paper is to present a guideline for the evaluation of products containing two or more constituent anthelmintic actives in a single dosage form for the treatment of nematode infections in these animals. At present, regulatory policies on the approval of such products vary across jurisdictions, and this World Association for the Advancement of Veterinary Parasitology (W.A.A.V.P.) guideline should enable the harmonization of the requirements. This guideline makes clear recommendations on the minimal standards needed, but stresses that registration dossiers for combination anthelmintic products submitted for approval must conform to the standards and practices already established in existing guidelines for anthelmintics.

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Predictors of HIV Drug‐Resistance Mutations in a Large Antiretroviral‐Naive Cohort Initiating Triple Antiretroviral Therapy

Abstract: High baseline pVLs and substantial but imperfect levels of adherence were major predictors of antiretroviral resistance.

Cited by 376 publications

References 34 publications

Nonadherence Increases the Risk of Hospitalization Among HIV-Infected Antiretroviral Naïve Patients Started on HAART

Nonadherence Increases the Risk of Hospitalization Among HIV-Infected Antiretroviral Naïve Patients Started on HAART

To tell or not to tell: Why people with HIV share or don't share with their physicians whether they are taking their medications as prescribed

World Association for the Advancement of Veterinary Parasitology (W.A.A.V.P.) Guideline: Anthelmintic combination products targeting nematode infections of ruminants and horses

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