Risk factors for virological failure and subtherapeutic antiretroviral drug concentrations in HIV-positive adults treated in rural northwestern Uganda

Hdl Handle:
http://hdl.handle.net/10144/71874
Title:
Risk factors for virological failure and subtherapeutic antiretroviral drug concentrations in HIV-positive adults treated in rural northwestern Uganda
Authors:
Ahoua, L; Guenther, G; Pinoges, L; Anguzu, P; Chaix, M L; Le Tiec, C; Balkan, S; Olson, D; Olaro, C; Pujades-Rodriguez, M
Journal:
BMC Infectious Diseases
Abstract:
ABSTRACT: BACKGROUND: Little is known about immunovirological treatment outcomes and adherence in HIV/AIDS patients on antiretroviral therapy (ART) treated using a simplified management approach in rural areas of developing countries, or about the main factors influencing those outcomes in clinical practice. METHODS: Cross-sectional immunovirological, pharmacological, and adherence outcomes were evaluated in all patients alive and on fixed-dose ART combinations for 24 months, and in a random sample of those treated for 12 months. Risk factors for virological failure (>1,000 copies/mL) and subtherapeutic antiretroviral (ARV) concentrations were investigated with multiple logistic regression. RESULTS: At 12 and 24 months of ART, 72% (n=701) and 70% (n=369) of patients, respectively, were alive and in care. About 8% and 38% of patients, respectively, were diagnosed with immunological failure; and 75% and 72% of patients, respectively, had undetectable HIV RNA (<400 copies/mL). Risk factors for virological failure (>1,000 copies/mL) were poor adherence, tuberculosis diagnosed after ART initiation, subtherapeutic NNRTI concentrations, general clinical symptoms, and lower weight than at baseline. About 14% of patients had low ARV plasma concentrations. Digestive symptoms and poor adherence to ART were risk factors for low ARV plasma concentrations. CONCLUSIONS: Efforts to improve both access to care and patient management to achieve better immunological and virological outcomes on ART are necessary to maximize the duration of first-line therapy.
Affiliation:
Epicentre, Paris, France; Médecins Sans Frontières, Arua, Uganda; Laboratory of Virology, Paris Descartes University, Paris, France; Laboratory of Toxicology, Bicêtre Hospital, Kremlin Bicêtre, France; Médecins Sans Frontières, Paris, France; Medical and Administrative Hospital Direction, Arua Regional Hospital, Arua, Uganda; International and Environmental Health, Institute of Social and Preventive Medicine, Bern, Switzerland
Issue Date:
3-Jun-2009
URI:
http://hdl.handle.net/10144/71874
DOI:
10.1186/1471-2334-9-81
PubMed ID:
19493344
Additional Links:
http://www.biomedcentral.com/1471-2334/9/81
Submitted date:
2009-06-24
Type:
Article
Language:
en
ISSN:
1471-2334
Appears in Collections:
HIV/AIDS

Full metadata record

DC FieldValue Language
dc.contributor.authorAhoua, L-
dc.contributor.authorGuenther, G-
dc.contributor.authorPinoges, L-
dc.contributor.authorAnguzu, P-
dc.contributor.authorChaix, M L-
dc.contributor.authorLe Tiec, C-
dc.contributor.authorBalkan, S-
dc.contributor.authorOlson, D-
dc.contributor.authorOlaro, C-
dc.contributor.authorPujades-Rodriguez, M-
dc.date.accessioned2009-06-30T09:00:05Z-
dc.date.available2009-06-30T09:00:05Z-
dc.date.issued2009-06-03-
dc.date.submitted2009-06-24-
dc.identifier.citationBMC Infect Dis 2009;9(1):81en
dc.identifier.issn1471-2334-
dc.identifier.pmid19493344-
dc.identifier.doi10.1186/1471-2334-9-81-
dc.identifier.urihttp://hdl.handle.net/10144/71874-
dc.description.abstractABSTRACT: BACKGROUND: Little is known about immunovirological treatment outcomes and adherence in HIV/AIDS patients on antiretroviral therapy (ART) treated using a simplified management approach in rural areas of developing countries, or about the main factors influencing those outcomes in clinical practice. METHODS: Cross-sectional immunovirological, pharmacological, and adherence outcomes were evaluated in all patients alive and on fixed-dose ART combinations for 24 months, and in a random sample of those treated for 12 months. Risk factors for virological failure (>1,000 copies/mL) and subtherapeutic antiretroviral (ARV) concentrations were investigated with multiple logistic regression. RESULTS: At 12 and 24 months of ART, 72% (n=701) and 70% (n=369) of patients, respectively, were alive and in care. About 8% and 38% of patients, respectively, were diagnosed with immunological failure; and 75% and 72% of patients, respectively, had undetectable HIV RNA (<400 copies/mL). Risk factors for virological failure (>1,000 copies/mL) were poor adherence, tuberculosis diagnosed after ART initiation, subtherapeutic NNRTI concentrations, general clinical symptoms, and lower weight than at baseline. About 14% of patients had low ARV plasma concentrations. Digestive symptoms and poor adherence to ART were risk factors for low ARV plasma concentrations. CONCLUSIONS: Efforts to improve both access to care and patient management to achieve better immunological and virological outcomes on ART are necessary to maximize the duration of first-line therapy.en
dc.languageENG-
dc.language.isoenen
dc.relation.urlhttp://www.biomedcentral.com/1471-2334/9/81en
dc.rightsArchived with thanks to BMC infectious diseasesen
dc.subject.meshHIVen
dc.subject.meshUgandaen
dc.subject.meshAntiretroviral Therapy, Highly Activeen
dc.subject.meshAdultsen
dc.subject.meshRural populationen
dc.subject.meshVirologyen
dc.titleRisk factors for virological failure and subtherapeutic antiretroviral drug concentrations in HIV-positive adults treated in rural northwestern Ugandaen
dc.typeArticleen
dc.contributor.departmentEpicentre, Paris, France; Médecins Sans Frontières, Arua, Uganda; Laboratory of Virology, Paris Descartes University, Paris, France; Laboratory of Toxicology, Bicêtre Hospital, Kremlin Bicêtre, France; Médecins Sans Frontières, Paris, France; Medical and Administrative Hospital Direction, Arua Regional Hospital, Arua, Uganda; International and Environmental Health, Institute of Social and Preventive Medicine, Bern, Switzerlanden
dc.identifier.journalBMC Infectious Diseasesen

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