Impact of Previous Virological Treatment Failures and Adherence on the Outcome of Antiretroviral Therapy in 2007

Abstract

BackgroundCombination antiretroviral treatment (cART) has been very successful, especially among selected patients in clinical trials. The aim of this study was to describe outcomes of cART on the population level in a large national cohort.MethodsCharacteristics of participants of the Swiss HIV Cohort Study on stable cART at two semiannual visits in 2007 were analyzed with respect to era of treatment initiation, number of previous virologically failed regimens and self reported adherence. Starting ART in the mono/dual era before HIV-1 RNA assays became available was counted as one failed regimen. Logistic regression was used to identify risk factors for virological failure between the two consecutive visits.ResultsOf 4541 patients 31.2% and 68.8% had initiated therapy in the mono/dual and cART era, respectively, and been on treatment for a median of 11.7 vs. 5.7 years. At visit 1 in 2007, the mean number of previous failed regimens was 3.2 vs. 0.5 and the viral load was undetectable (<50 copies/ml) in 84.6% vs. 89.1% of the participants, respectively. Adjusted odds ratios of a detectable viral load at visit 2 for participants from the mono/dual era with a history of 2 and 3, 4, >4 previous failures compared to 1 were 0.9 (95% CI 0.4–1.7), 0.8 (0.4–1.6), 1.6 (0.8–3.2), 3.3 (1.7–6.6) respectively, and 2.3 (1.1–4.8) for >2 missed cART doses during the last month, compared to perfect adherence. From the cART era, odds ratios with a history of 1, 2 and >2 previous failures compared to none were 1.8 (95% CI 1.3–2.5), 2.8 (1.7–4.5) and 7.8 (4.5–13.5), respectively, and 2.8 (1.6–4.8) for >2 missed cART doses during the last month, compared to perfect adherence.ConclusionsA higher number of previous virologically failed regimens, and imperfect adherence to therapy were independent predictors of imminent virological failure.

Conceptual framework for understanding the bidirectional links between food insecurity and HIV/AIDS

“…In addition to food insecurity, poverty and the attendant inability to afford user fees and transport fees are well known to adversely affect ART adherence in resource-limited settings (159,169). HAART treatment interruptions (171)(172)(173)(174) and average HAART adherence (175)(176)(177), in turn, are wellknown determinants of HIV treatment outcomes.…”

Long-term immunological outcomes in treated HIV-infected individuals in high-income and low-middle income countries

“…The UK HIV cohort reported the 8-year risk of virological failure in those who started treatment after 1998 to be around 28% [95% confidence interval (CI) 27-31%], but the probability of detection of any resistance-related mutation in the virus was lower at 17% (95% CI 27-31%) [34 ]. Further, risk of viral rebound decreases with longer duration of viral suppression, even after adjusting for adherence [35,36], and increases with greater number of previously failed regimens [37]. This suggests that patients with treatment failure will be an important group with a higher subsequent risk for failure.…”

“…Adherence to cART is an important determinant of successful cART [37,79,80]. The adherence to cART appears to be good in LMICs settings.…”

Living Situation Affects Adherence to Combination Antiretroviral Therapy in HIV-Infected Adolescents in Rwanda: A Qualitative Study

“…Poor adherence is a driving cause of treatment failure, HIV drug resistance, disease progression [10]–[12] and HIV transmission [13], [14], whereas 95% cART adherence is associated with reduced morbidity and mortality [15]–[17]. Therefore adherence should be one of the main concerns when providing cART, especially in resource limited settings where second and third line therapies are not available or generally too expensive.…”