Acta Scientific Microbiology (ASMI) (ISSN: 2581-3226)

Research Article Volume 3 Issue 10

Suboptimal Adherence and Associated Factors Contributing to Virological Failure on First Line ART at a Private Tertiary Care Centre in South India: Implications for Individualized Adherence Interventions in Resource-limited Settings

Laxman G Jessani*, Ram Gopalakrishnan, Suresh D, S Nambi and V Ramasubramanian

Department of Infectious Diseases, Apollo Hospital, Chennai

*Corresponding Author: Laxman G Jessani, Department of Infectious Diseases, Apollo Hospital, Chennai.

Received: August 26, 2020; Published: September 16, 2020

×

Abstract

Background: Suboptimal adherence to ART can lead to HIV drug resistance. We studied the incidence and factors leading to first-line ART failure and the socio-demographic, behavioral and clinical risk factors associated with non-adherence to ART.

Methods: We carried out a retrospective case-control study of adult HIV-1 positive patients who were on first line ART over a period of 10 years. Adherence and history of treatment interruptions for > 48h were noted by self-report. Kaplan Meier survival curves (Figure 2) were used to estimate the median time to first line ART treatment failure. Logistic regression and Cox proportional hazard model were used to predict ART treatment failure.

Results: Among 290 participants, 80 (27.58%) cumulatively had first-line failure. Patients who had virological failure on first line ART were taken as cases (n = 80) and those who were virologically suppressed were taken as controls (n = 210). Mean time to failure was 41.16 ± 11.11 months. 45% failed after more than 5 yrs on treatment: only 4% failed within the first 6 months. Lower baseline CD4 count, WHO stage IV, CDC stage 3 and poor adherence were significantly associated with first line failure. 70% of patients reported suboptimal adherence while 68% reported treatment interruptions. Poor adherence was significantly associated with virological failure (P < 0.001) with OR = 4.22 (2.68 - 6.62) and CD4 count < 200 and ART duration > 3 years was associated with poorer adherence.

Conclusion: Our study demonstrates a strong association between suboptimal adherence, virological failure and drug resistance among patients on first-line ART.

Keywords: HIV/AIDS; Suboptimal; Adherence; Virological Failure

×

References

  1. Patel K., et al. “Long-term effectiveness of highly active antiretroviral therapy on the survival of children and adolescents with HIV infection: a 10-year follow-up study”. Clinical Infectious Diseases4 (2008): 507-515.
  2. Lucas GM. “Antiretroviral adherence, drug resistance, viral fitness and HIV disease progression: a tangled web is woven”. Journal of Antimicrobial Chemotherapy 4 (2005): 413-416.
  3. Arnsten JH., et al. “Antiretroviral therapy adherence and viral suppression in HIV-infected drug users: comparison of self-report and electronic monitoring”. Clinical Infectious Diseases8 (2001): 1417-1423.
  4. Mills EJ., et al. “Adherence to antiretroviral therapy in sub-Saharan Africa and North America: a meta-analysis”. JAMA6 (2006): 679-690.
  5. Diabate S., et al. “Determinants of adherence to highly active antiretroviral therapy among HIV-1-infected patients in Cote d'Ivoire”. AIDS13 (2007): 1799-1803.
  6. Gill CJ., et al. “No room for complacency about adherence to antiretroviral therapy in sub-Saharan Africa”. AIDS 12 (2005): 1243-1249.
  7. Ekstrand ML., et al. “Developing useful highly active antiretroviral therapy adherence measures for India: the Prerana study”. Journal of Acquired Immune Deficiency Syndromes3 (2010): 415-416.
  8. Cauldbeck MB., et al. “Adherence to anti-retroviral therapy among HIV patients in Bangalore, India”. AIDS Research Therapy 6 (2009): 7.
  9. Sarna A., et al. “Adherence to antiretroviral therapy and its determinants amongst HIV patients in India”. Indian Journal of Medical Research 1 (2008): 28-36.
  10. Shah B., et al. “Adherence to antiretroviral therapy and virologic suppression among HIV-infected persons receiving care in private clinics in Mumbai, India”. Clinical Infectious Diseases9 (2007): 1235-1244.
  11. Sharma M., et al. “Access, adherence, quality and impact of ARV provision to current and ex-injecting drug users in Manipur (India): an initial assessment”. International Journal of Drug Policy 4 (2007): 319-325.
  12. Barth RE., et al. “Long-term outcome of children receiving antiretroviral treatment in rural South Africa: substantial virologic failure on first-line treatment”. Pediatric Infectious Disease Journal 1 (2011): 52-56.
  13. Reynolds SJ., et al. “Failure of immunologic criteria to appropriately identify antiretroviral treatment failure in Uganda”. AIDS6 (2009): 697-700.
  14. Emmett SD., et al. “Predicting virologic failure among HIV-1-infected children receiving antiretroviral therapy in Tanzania: a cross-sectional study”. Journal of Acquired Immune Deficiency Syndromes4 (2010): 368-375.
  15. Bangsberg DR., et al. “Non-adherence to highly active antiretroviral therapy predicts progression to AIDS”. AIDS9 (2001): 1181-1183.
  16. WHO: Antiretroviral therapy for HIV infection in adults and adolescents: recommendation for a public health approach (2015).
  17. Jittamala P., et al. “Predictors of virologic failure and genotypic resistance mutation patterns in thai children receiving non-nucleoside reverse transcriptase inhibitor-based antiretroviral therapy”. Pediatric Infectious Disease Journal 9 (2009): 826-830.
  18. Kamya MR., et al. “Predictors of long-term viral failure among ugandan children and adults treated with antiretroviral therapy”. Journal of Acquired Immune Deficiency Syndromes2 (2007): 187-193.
  19. Ekstrand ML., et al. “Suboptimal adherence associated with virological failure and resistance mutations to first-line highly active antiretroviral therapy (HAART) in Bangalore, India”. International Health1 (2011): 27-34.
  20. Boettiger DC., et al. “Efficacy of second-line antiretroviral therapy among people living with HIV/AIDS in Asia: results from the TREAT Asia HIV observational database”. Journal of Acquired Immune Deficiency Syndromes2 (2015): 186-195.
  21. Kumarasamy N., et al. “High frequency of clinically significant mutations after first-line generic highly active antiretroviral therapy failure: implications for second-line options in resource-limited settings”. Clinical Infectious Diseases2 (2009): 306-309.
  22. Pujades-Rodriguez M., et al. “Treatment failure and mortality factors in patients receiving second-line HIV therapy in resource-limited countries”. JAMA3 (2010): 303-312.
  23. Ferradini L., et al. “Scaling up of highly active antiretroviral therapy in a rural district of Malawi: an effectiveness assessment”. Lancet 9519 (2006): 1335-1342.
  24. Oyugi JH., et al. “Multiple validated measures of adherence indicate high levels of adherence to generic HIV antiretroviral therapy in a resource-limited setting”. Journal of Acquired Immune Deficiency Syndromes5 (2004): 1100-1102.
  25. Kumarasamy N., et al. “Barriers and facilitators to antiretroviral medication adherence among patients with HIV in Chennai, India: a qualitative study”. AIDS Patient Care STDS8 (2005): 526-537.
  26. Hendershot CS., et al. “Alcohol use and antiretroviral adherence: review and meta-analysis”. Journal of Acquired Immune Deficiency Syndromes2 (2009): 180-202.
  27. Samet JH., et al. “Alcohol consumption and HIV disease progression”. Journal of Acquired Immune Deficiency Syndromes2 (2007): 194-199.
  28. Strauss SM., et al. “HIV care providers' implementation of routine alcohol reduction support for their patients”. AIDS Patient Care STDS3 (2009): 211-218.
  29. Mellins CA., et al. “Adherence to antiretroviral medications and medical care in HIV-infected adults diagnosed with mental and substance abuse disorders”. AIDS Care2 (2009): 168-177.
  30. Balakrishnan P., et al. “HIV type 1 genotypic variation in an antiretroviral treatment-naive population in southern India”. AIDS Research and Human Retroviruses 4 (2005): 301-305.

 

 

×

Citation

Citation: Laxman G Jessani., et al. “Suboptimal Adherence and Associated Factors Contributing to Virological Failure on First Line ART at a Private Tertiary Care Centre in South India: Implications for Individualized Adherence Interventions in Resource-limited Settings". Acta Scientific Microbiology 3.10 (2020): 42-52.



Indexed In






News and Events


  • Certification for Review
    Acta Scientific certifies the Editors/reviewers for their review done towards the assigned articles of the respective journals.
  • Submission Timeline for Upcoming Issue
    The last date for submission of articles for regular Issues is December 15, 2020.
  • Publication Certificate
    Authors will be issued a "Publication Certificate" as a mark of appreciation for publishing their work.
  • Best Article of the Issue
    The Editors will elect one Best Article after each issue release. The authors of this article will be provided with a certificate of “Best Article of the Issue”.
  • Welcoming Article Submission
    Acta Scientific delightfully welcomes active researchers for submission of articles towards the upcoming issue of respective journals.
  • Contact US