Adherence to Antiretroviral Therapy and Virologic Suppression among HIV-Infected Persons Receiving Care in Private Clinics in Mumbai, India

Shah, Bijal; Walshe, Louise; Saple, D G; Mehta, Shruti H.; Ramnani, Jeetender P; Kharkar, R. D.; Bollinger, Robert C.; Gupta, Amita

doi:10.1086/513429

Cited by 91 publications

(122 citation statements)

References 37 publications

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“…The adjusted PAF for alcohol use was 11.4% (95% CI: 0.05-0.17), for low/intermediate general health perceptions was 37.3% (95% CI: 0.02-0.60), for high/intermediate distress was 24.0% (95% CI: À0.05-0.45), and for CD4 cell count greater than 500 cells per microliter was 10.0% (95% CI: À0.01-0.20).…”

Section: Multivariable Analysis Of Risk Factors Of Antiretroviral Nonmentioning

confidence: 98%

“…15 A recent study from western India conducted at private health clinics found that among patients paying for treatment out-ofpocket, three fourths of patients had 95% adherence or higher. 24 Earlier studies monitoring treatment adherence from resource-limited setting have generally been conducted soon after patients initiated HAART, when patients were experiencing dramatic increases in health status. However, in the current study, half the population had been HAARTexperienced for over 2 years, suggesting the need for sustained efforts to maintain high levels of adherence well after the initial immune-restorative effects of treatment.…”

Section: Venkatesh Et Almentioning

confidence: 99%

“…[15][16][17][18][19][20][21][22][23] Despite expanding access to HAART in India, quantitative studies examining behavioral correlates of adherence remain limited. 24 We had earlier undertaken one qualitative study 25 and one chart review study 26 to assess barriers and facilitators of HAART adherence in South India, which were conducted before the further reduction in cost and roll-out of subsidized HAART. However, these studies were limited in that the qualitative study was hypothesis generating, and the chart review was limited to data that were in patients' medical records.…”

mentioning

confidence: 99%

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Predictors of Nonadherence to Highly Active Antiretroviral Therapy Among HIV-Infected South Indians in Clinical Care: Implications for Developing Adherence Interventions in Resource-Limited Settings

Venkatesh

Srikrishnan

Mayer

et al. 2010

AIDS Patient Care and STDs

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In light of the increasing availability of generic highly active antiretroviral therapy (HAART) in India, further data are needed to examine variables associated with HAART nonadherence among HIV-infected Indians in clinical care. We conducted a cross-sectional analysis of 198 HIV-infected South Indian men and women between January and April 2008 receiving first-line non-nucleoside reverse transcriptase inhibitor (NNRTI)-based HAART. Nonadherence was defined as taking less than 95% of HAART doses in the last 1 month, and was examined using multivariable logistic regression models. Half of the participants reported less than 95% adherence to HAART, and 50% had been on HAART for more than 24 months. The median CD4 cell count was 435 cells per microliter. An increased odds of nonadherence was found for participants with current CD4 cell counts greater than 500 cells per microliter (adjusted odds ratio [AOR]

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Section: Multivariable Analysis Of Risk Factors Of Antiretroviral Nonmentioning

confidence: 98%

Section: Venkatesh Et Almentioning

confidence: 99%

mentioning

confidence: 99%

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Predictors of Nonadherence to Highly Active Antiretroviral Therapy Among HIV-Infected South Indians in Clinical Care: Implications for Developing Adherence Interventions in Resource-Limited Settings

Venkatesh

Srikrishnan

Mayer

et al. 2010

AIDS Patient Care and STDs

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“…As per data in March 2013, there are 18.13 lakh people living with HIV/AIDS in India with around 1.16 lakh new HIV infections among adults every year. 1 As per NACO 2013 guidelines, all HIV infected patients with a CD 4 + count of ≤350 cells/mm 3 or those with WHO clinical stage 3 or 4 irrespective of CD 4 + count should be initiated on ART. 1 The regimen selected is based on their efficacy, side effects, drug availability, cost, potential drug interactions, comorbidities, opportunistic infections (OIs), and need for laboratory monitoring.…”

Section: Introductionmentioning

confidence: 99%

“…[3][4][5] Some studies have assessed survival, morbidity and medication adherence among Indian patients receiving ART in the private and nongovernmental sectors. [3][4][5] This study examined treatment outcomes in terms of immunological improvement, improvement in weight and haemoglobin, occurrence of opportunistic infections and adverse reactions using routinely collected ART data from the tertiary care hospital setting. Further, a nonrandomized comparison study of TDF with other commonly used nucleoside reverse transcriptase inhibitors based regimens was undertaken.…”

Section: Introductionmentioning

confidence: 99%

Antiretroviral therapy outcome in human immuno-deficiency virus infected patients in a tertiary care hospital

Manohar

Shenoy

Varma

et al. 2016

Int J Basic Clin Pharmacol

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Background: Human immunodeficiency virus (HIV) presently accounts for the highest number of deaths due to any infective agent in the world. The present study assessed the one year treatment outcome following antiretroviral therapy in HIV positive, treatment naïve patients in a tertiary care hospital. Methods: Adult HIV positive, antiretroviral treatment naive patients who were started on antiretroviral therapy (ART) between 1 st January 2011 and 31 st May 2013 were included in the study. Data was collected from their case records. CD4+cell count, haemoglobin level, weight, occurrence of opportunistic infections (OIs) and adverse drug reactions (ADRs) were analysed at baseline, 6 and 12 months following start of antiretroviral therapy. Data was analysed using parametric and nonparametric tests. Results: Data of 325 patients was analysed. Overall, the median increase in CD 4 + count at 1 year after initiation of treatment was observed to be clinically significant. Patients on tenofovir based regimen showed a significantly greater increase in the median CD 4 + count (P = 1.12×10 -05 ) and haemoglobin (P = 0.002) as compared to those on non-tenofovir based regimen. A total of 151 ADRs were recorded in the study, of which the most common were skin rash 24%, anaemia and gastrointestinal side effects 17% each. Frequency of opportunistic infections gradually declined after ART. At the end of 1 year of treatment, the cumulative loss to follow up was 7.4%. Conclusions: By following the current national guidelines, the desired immunological and clinical response following initiation of ART can be achieved while minimizing drug toxicity.

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Virological failure and drug resistance during first line anti‐retroviral treatment in Indonesia

Fibriani

Wisaksana

Indrati

et al. 2013

Journal of Medical Virology

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The virological response and development of drug resistance during first-line anti-retroviral treatment (ART) were studied in Indonesia where the majority of patients infected with HIV have a history of injecting drug use, which is often linked with lower treatment adherence and development of drug-resistance. As many as 575 patients starting ART between September 2007 and March 2010 in Hasan Sadikin Hospital Bandung were followed prospectively. Clinical and laboratory monitoring was performed every 6 months. Plasma samples with HIV-RNA ≥ 400 copies/ml were examined for drug resistance mutations. Most patients were male (72.3%), 59.7% had a history of injecting drug use, and the median CD4+ cells count before start of ART was 35 cells/mm(3) (IQR 10-104). From 438 HIV patients with HIV-RNA measurements, 40 (9.1%) subjects had HIV-RNA ≥ 400 copies/ml after 24 weeks (median follow-up 16 (IQR 8-25) months). Of these failing patients 16 (47%) subjects had drug resistance mutations, predominantly M184V (35.3%), Y181C (23.5%), K103N (11.7%), and TAMs (11.7%). A history of treatment discontinuation ≥ 1 month, reported by 5.3% (23) of patients, was strongly associated with virological failure (adjusted OR 12.64, 95% CI 4.51-35.41); and a history of injecting drug use was not (OR 0.75, 95% CI 0.38-1.46). This is the largest and most systematic evaluation of virological response to first line ART in Indonesia. Patients in this cohort responded well to first line ART, with low rates of virological failure and drug resistance. A history of injecting drug use should not be a reason to withhold ART in this setting.

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Adherence to Antiretroviral Therapy and Virologic Suppression among HIV-Infected Persons Receiving Care in Private Clinics in Mumbai, India

Cited by 91 publications

References 37 publications

Predictors of Nonadherence to Highly Active Antiretroviral Therapy Among HIV-Infected South Indians in Clinical Care: Implications for Developing Adherence Interventions in Resource-Limited Settings

Predictors of Nonadherence to Highly Active Antiretroviral Therapy Among HIV-Infected South Indians in Clinical Care: Implications for Developing Adherence Interventions in Resource-Limited Settings

Antiretroviral therapy outcome in human immuno-deficiency virus infected patients in a tertiary care hospital

Virological failure and drug resistance during first line anti‐retroviral treatment in Indonesia

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