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    Apr 22, 2021
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    Risk factors for virological failure and subtherapeutic antiretroviral drug concentrations in HIV-positive adults treated in rural northwestern Uganda

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    Authors
    Ahoua, L
    Guenther, G
    Pinoges, L
    Anguzu, P
    Chaix, M L
    Le Tiec, C
    Balkan, S
    Olson, D
    Olaro, C
    Pujades-Rodriguez, M
    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
    2009-06-03
    Submitted date
    2009-06-24
    
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    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.
    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
    Type
    Article
    Language
    en
    ISSN
    1471-2334
    ae974a485f413a2113503eed53cd6c53
    10.1186/1471-2334-9-81
    Scopus Count
    Collections
    HIV/AIDS

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