Adherence to antiretroviral therapy assessed by drug level monitoring and self-report in cameroon

Hdl Handle:
http://hdl.handle.net/10144/116998
Title:
Adherence to antiretroviral therapy assessed by drug level monitoring and self-report in cameroon
Authors:
Kouanfack, Charles; Laurent, Christian; Peytavin, Gilles; Ciaffi, Laura; Ngolle, Maguy; Nkene, Yvette Mawamba; Essomba, Claudine; Calmy, Alexandra; Mpoudi-Ngolé, Eitel; Delaporte, Eric; Koulla-Shiro, Sinata
Journal:
Journal of Acquired Immune Deficiency Syndromes (1999)
Abstract:
OBJECTIVES: To compare adherence to antiretroviral therapy using drug level monitoring and self-report and to explore the relation between these 2 methods and viral load measurements. METHODS: Sixty patients received a fixed-dose combination of nevirapine, stavudine, and lamivudine in a clinical study in Cameroon. Adherence was assessed every 6 months until month 36 by nevirapine minimal plasma concentration and self-report. Plasma HIV-1 viral load was determined at the same time. Analyses included 159 complete observations. RESULTS: The proportion of patients labeled as "adherent" was significantly lower using nevirapine monitoring (88.7%, 95% confidence interval [CI]: 82.7 to 93.2) than self-report (97.5%, CI: 93.7 to 99.3; P = 0.002). Virologic failure was associated with the nevirapine concentration (adjusted odds ratio [aOR] = 4.43; P = 0.018) but not with the self-reported adherence (aOR = 0.84; P = 0.9). As compared with the virologic outcome, the sensitivity of nevirapine level monitoring for predicting inadequate adherence was 20.5%, the specificity was 91.7%, the positive predictive value was 44.4%, and the negative predictive value was 78.0%. For self-report, the respective values were 2.6%, 97.5%, 25.0%, and 75.5%. CONCLUSIONS: Drug level monitoring provided a more reliable estimate of adherence than self-report. This method could be used in research settings. Operational research is required to define how to improve the accuracy of the self-report method because it is the most feasible method in clinical practice.
Affiliation:
Central Hospital, Yaoundé, Cameroon; Institut de recherche pour le developpement, University of Montpellier, Montpellier, France; Laboratoire de Toxicologie et de Dosage de Medicaments, Centre Hospitalier Universitaire Bichat Claude Bernard, Paris, France; Medecins Sans Frontieres, Geneva, Switzerland; Projet PRESICA (Prevention du Sida au Cameroun), Military Hospital, Yaounde, Cameroon
Issue Date:
1-Jun-2008
URI:
http://hdl.handle.net/10144/116998
DOI:
10.1097/QAI.0b013e3181743955
PubMed ID:
18520681
Additional Links:
http://journals.lww.com/jaids/pages/articleviewer.aspx?year=2008&issue=06010&article=00015&type=abstract
Type:
Article
Language:
en
ISSN:
1525-4135
Appears in Collections:
HIV/AIDS

Full metadata record

DC FieldValue Language
dc.contributor.authorKouanfack, Charlesen
dc.contributor.authorLaurent, Christianen
dc.contributor.authorPeytavin, Gillesen
dc.contributor.authorCiaffi, Lauraen
dc.contributor.authorNgolle, Maguyen
dc.contributor.authorNkene, Yvette Mawambaen
dc.contributor.authorEssomba, Claudineen
dc.contributor.authorCalmy, Alexandraen
dc.contributor.authorMpoudi-Ngolé, Eitelen
dc.contributor.authorDelaporte, Ericen
dc.contributor.authorKoulla-Shiro, Sinataen
dc.date.accessioned2010-12-02T19:41:38Z-
dc.date.available2010-12-02T19:41:38Z-
dc.date.issued2008-06-01-
dc.identifier.citationJ. Acquir. Immune Defic. Syndr. 2008;48(2):216-9en
dc.identifier.issn1525-4135-
dc.identifier.pmid18520681-
dc.identifier.doi10.1097/QAI.0b013e3181743955-
dc.identifier.urihttp://hdl.handle.net/10144/116998-
dc.description.abstractOBJECTIVES: To compare adherence to antiretroviral therapy using drug level monitoring and self-report and to explore the relation between these 2 methods and viral load measurements. METHODS: Sixty patients received a fixed-dose combination of nevirapine, stavudine, and lamivudine in a clinical study in Cameroon. Adherence was assessed every 6 months until month 36 by nevirapine minimal plasma concentration and self-report. Plasma HIV-1 viral load was determined at the same time. Analyses included 159 complete observations. RESULTS: The proportion of patients labeled as "adherent" was significantly lower using nevirapine monitoring (88.7%, 95% confidence interval [CI]: 82.7 to 93.2) than self-report (97.5%, CI: 93.7 to 99.3; P = 0.002). Virologic failure was associated with the nevirapine concentration (adjusted odds ratio [aOR] = 4.43; P = 0.018) but not with the self-reported adherence (aOR = 0.84; P = 0.9). As compared with the virologic outcome, the sensitivity of nevirapine level monitoring for predicting inadequate adherence was 20.5%, the specificity was 91.7%, the positive predictive value was 44.4%, and the negative predictive value was 78.0%. For self-report, the respective values were 2.6%, 97.5%, 25.0%, and 75.5%. CONCLUSIONS: Drug level monitoring provided a more reliable estimate of adherence than self-report. This method could be used in research settings. Operational research is required to define how to improve the accuracy of the self-report method because it is the most feasible method in clinical practice.en
dc.language.isoenen
dc.relation.urlhttp://journals.lww.com/jaids/pages/articleviewer.aspx?year=2008&issue=06010&article=00015&type=abstracten
dc.rightsArchived with thanks to Journal of Acquired Immune Deficiency Syndromes (1999)en
dc.subject.meshAdulten
dc.subject.meshAnti-HIV Agentsen
dc.subject.meshDrug Monitoringen
dc.subject.meshDrug Therapy, Combinationen
dc.subject.meshFemaleen
dc.subject.meshHIV Infectionsen
dc.subject.meshHumansen
dc.subject.meshMaleen
dc.subject.meshNevirapineen
dc.subject.meshPatient Complianceen
dc.subject.meshViral Loaden
dc.titleAdherence to antiretroviral therapy assessed by drug level monitoring and self-report in cameroonen
dc.typeArticleen
dc.contributor.departmentCentral Hospital, Yaoundé, Cameroon; Institut de recherche pour le developpement, University of Montpellier, Montpellier, France; Laboratoire de Toxicologie et de Dosage de Medicaments, Centre Hospitalier Universitaire Bichat Claude Bernard, Paris, France; Medecins Sans Frontieres, Geneva, Switzerland; Projet PRESICA (Prevention du Sida au Cameroun), Military Hospital, Yaounde, Cameroonen
dc.identifier.journalJournal of Acquired Immune Deficiency Syndromes (1999)en
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