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

      Ahoua, L; Guenther, G; Pinoges, L; Anguzu, P; Chaix, M L; Le Tiec, C; Balkan, S; Olson, D; Olaro, C; Pujades-Rodriguez, M; 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 (2009-06-03)
      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.