Virological Suppression Achieved with Suboptimal Adherence Levels among South African Children Receiving Boosted Protease Inhibitor–Based Antiretroviral Therapy

Müller, Alex; Myer, Landon; Jaspan, Heather B.

doi:10.1086/595553

Cited by 21 publications

(18 citation statements)

References 15 publications

(17 reference statements)

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“…viral failure) (Mugavero et al, 2009). General mistrust did not significantly predict adherence at a clinically significant rate of ≥80% (Bangsberg, 2006; Shuter et al, 2007; McNabb et al, 2001; Gulick, 2006; Muller et al, 2009; Kobin and Sheth, 2011) although our analyses may have been limited by our relatively small sample size.…”

Section: Discussionmentioning

confidence: 79%

Medical mistrust is related to lower longitudinal medication adherence among African-American males with HIV

et al. 2014

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African-Americans living with HIV show worse health behaviors (e.g. medication adherence) and outcomes (e.g. viral suppression) than do their White counterparts. In a 6-month longitudinal study, we investigated whether medical mistrust among African-American males with HIV (214 enrolled, 140 with longitudinal data) predicted lower electronically monitored antiretroviral medication adherence. General medical mistrust (e.g. suspicion towards providers), but not racism-related mistrust (e.g. belief that providers treat African-Americans poorly due to race), predicted lower continuous medication adherence over time (b=−.08, se=.04, p=.03). Medical mistrust may contribute to poor health outcomes. Intervention efforts that address mistrust may improve adherence among African-Americans with HIV.

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Section: Discussionmentioning

confidence: 79%

Medical mistrust is related to lower longitudinal medication adherence among African-American males with HIV

et al. 2014

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“…[16,20,21,23–25,27,28,30–37,79–92] Furthermore, the frequency of therapeutic failure seems quite higher when NNRTI-based regimens are used in 1st-line treatment, [82] ranging from 12% to 98% [16,20,21,24,33,37,38,79–82,84,87,88,92,93] than when PI-based regimen are used, ranging from 26% to 44%. [83,86,87,89,91] …”

Section: Discussionmentioning

confidence: 99%

High levels of virological failure with major genotypic resistance mutations in HIV-1-infected children after 5 years of care according to WHO-recommended 1st-line and 2nd-line antiretroviral regimens in the Central African Republic

et al. 2017

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A large cohort of 220 HIV-1-infected children (median [range] age: 12 [4–17] years) was cared and followed up in the Central African Republic, including 198 in 1st-line and 22 in 2nd-line antiretroviral regimens. Patients were monitored clinically and biologically for HIV-1 RNA load and drug resistance mutations (DRMs) genotyping. A total of 87 (40%) study children were virological responders and 133 (60%) nonresponders. In children with detectable viral load, the majority (129; 97%) represented a virological failure. In children receiving 1st-line regimens in virological failure for whom genotypic resistance test was available, 45% displayed viruses harboring at least 1 DRM to NNRTI or NRTI, and 26% showed at least 1 major DRM to NNRTI or NRTI; more than half of children in 1st-line regimens were resistant to 1st-generation NNRTI and 24% of the children in 1st-line regimens had a major DRMs to PI. Virological failure and selection of DRMs were both associated with poor adherence. These observations demonstrate high rate of virological failure after 3 to 5 years of 1st-line or 2nd-line antiretroviral treatment, which is generally associated with DRMs and therapeutic failure. Overall, more than half (55%) of children receiving 1st-line antiretroviral treatment for a median of 3.4 years showed virological failure and antiretroviral-resistance and thus eligible to 2nd-line treatment. Furthermore, two-third (64%) of children under 2nd-line therapy were eligible to 3rd-line regimen. Taken together, these observations point the necessity to monitor antiretroviral-treated children by plasma HIV-1 RNA load to diagnose as early as possible the therapeutic failure and operate switch to a new therapeutic line.

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“…7,[11][12][13][14]20,[25][26][27][28][29][30] Furthermore, the rate of therapeutic failure appears greater when NNRTI-based regimens are used as a first-line treatment, and then ranges from 20% to 75%, 7,[11][12][13][14]20,25,28,29 compared to when a PI-based regimen is used (range: 26-36%). 26,27 In the series of children reported here, who were prescribed mostly with a first-line ARV treatment, including NNRTI, virological failure was frequently associated with major NNRTI-resistance mutations, whereas no major PI-resistance mutations were observed in children treated by firstline PI therapy. These observations emphasize the possibility of using PI more frequently as a pediatric first-line regimen in Africa.…”

Section: Discussionmentioning

confidence: 99%

Virological Response and Resistance Profiles After 18 to 30 Months of First- or Second-/Third-Line Antiretroviral Treatment: A Cross-Sectional Evaluation in HIV Type 1-Infected Children Living in the Central African Republic

Charpentier

Gody

Mbitikon

et al. 2012

AIDS Research and Human Retroviruses

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A total of 242 HIV-1-infected children were followed up at the Complexe Pédiatrique of Bangui, Central African Republic, including 165 receiving antiretroviral treatment in first- (n=150) or second-/third-line (n=15) regimens. They were prospectively included in a study, in 2009, to assess their virological status and prevalence of antiretroviral drug-resistance mutations in cases of virological failure, according to revised 2010 WHO criteria (e.g., HIV-1 RNA >3.7 log(10) copies/ml). Detectable plasma HIV-1 RNA was observed in 53% of children under first-line treatment, and virological failure was diagnosed in 40%, which was associated in 85% of cases with viruses harboring at least one drug-resistance mutation to nucleoside reverse transcriptase inhibitors (NRTI) or nonnucleoside reverse transcriptase inhibitors (NNRTI), and in 36% of cases with at least one major drug-resistance mutation to NRTI or NNRTI when excluding the M184V mutation. Overall, the proportion of children receiving a first-line regimen for a median of 18 months with virological failure associated with drug-resistance mutations, and thus eligible for a second-line treatment, was estimated at 34% of the whole cohort. In children under second-/third-line therapy, virological failure occurred in 47%, plus at least one major drug-resistance mutation to NRTI or NNRTI, though less commonly to protease inhibitors. Taken together, these findings argue in favor of the urgent need to improve distribution of pediatric antiretroviral drugs in the Central African Republic, to increase adherence by treated children, and to offer adequate HIV biological monitoring.

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Virological Suppression Achieved with Suboptimal Adherence Levels among South African Children Receiving Boosted Protease Inhibitor–Based Antiretroviral Therapy

Cited by 21 publications

References 15 publications

Medical mistrust is related to lower longitudinal medication adherence among African-American males with HIV

Medical mistrust is related to lower longitudinal medication adherence among African-American males with HIV

High levels of virological failure with major genotypic resistance mutations in HIV-1-infected children after 5 years of care according to WHO-recommended 1st-line and 2nd-line antiretroviral regimens in the Central African Republic

Virological Response and Resistance Profiles After 18 to 30 Months of First- or Second-/Third-Line Antiretroviral Treatment: A Cross-Sectional Evaluation in HIV Type 1-Infected Children Living in the Central African Republic

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