Bastard, M;
Pinoges, L;
Balkan, S;
Szumilin, E;
Ferreyra, C;
Pujades-Rodriguez, M;
(2012)
Timeliness of clinic attendance is a good predictor of virological response and resistance to antiretroviral drugs in HIV-infected patients.
PLoS One
, 7
(11)
, Article e49091. 10.1371/journal.pone.0049091.
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Abstract
Background Ensuring long-term adherence to therapy is essential for the success of HIV treatment. As access to viral load monitoring and genotyping is poor in resource-limited settings, a simple tool to monitor adherence is needed. We assessed the relationship between an indicator based on timeliness of clinic attendance and virological response and HIV drug resistance. Methods Data from 7 virological cross-sectional studies were pooled. An adherence indicator was calculated as the number of appointments attended with delay divided by the number of months between antiretroviral treatment (ART) initiation and date of virological testing and multiplying this by 100. Delays of 1 or more to 5 or more days were considered in turn. Multivariate random-intercept logistic regression was fitted to examine the effect on outcomes, separately for adults and children. Results A total of 3580 adults and 253 children were included. Adults were followed for a median of 26.0 months (IQR 12.8-45.0) and attended a median of 24 visits (IQR 13–34). The 1-day delay adherence indicator was strongly associated with viral load suppression (OR 0.96, 95% CI 0.95–0.97 per unit increase), virological failure (OR 1.05, 95% CI 1.03–1.06) and HIV drug resistance (OR 1.03, 95% CI 1.01–1.05) after adjusting for initial age and CD4 count, previous ART experience, type of regimen and Tuberculosis diagnosis at start of therapy. Similar results were observed in children. Conclusion An adherence indicator based on timeliness of clinic attendance predicts strongly both virological response and drug resistance, and could help to timely identify non-adherent patients in settings where viral load monitoring is not available.
| Type: | Article |
|---|---|
| Title: | Timeliness of clinic attendance is a good predictor of virological response and resistance to antiretroviral drugs in HIV-infected patients |
| Location: | United States |
| Open access status: | An open access version is available from UCL Discovery |
| DOI: | 10.1371/journal.pone.0049091 |
| Publisher version: | http://dx.doi.org/10.1371/journal.pone.0049091 |
| Language: | English |
| Additional information: | © 2012 Bastard et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. PMCID: PMC3492309 |
| Keywords: | Adult, Anti-Retroviral Agents, Antiretroviral Therapy, Highly Active, Appointments and Schedules, Child, Child, Preschool, Drug Resistance, Viral, Female, Genotype, HIV Infections, HIV-1, Humans, Male, Viral Load |
| UCL classification: | UCL |
| URI: | https://discovery.ucl.ac.uk/id/eprint/1399558 |
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