Rate of viral load change and adherence of HIV adult patients treated with Efavirenz or Nevirapine antiretroviral regimens at 24 and 48 weeks in Yaoundé, Cameroon: a longitudinal cohort study

Abstract

Background HIV-load decrease and suppression over time is associated with consistent adherence to antiretroviral therapy (ART). Our study aimed to evaluate the difference in viral load and adherence of patients treated with a combination of either Tenofovir (TDF), Lamivudine (3TC) and Efavirenz (EFV) or TDF / Zidovudine (AZT), 3TC and Nevirapine (NVP) regimens at 24 and 48 weeks. Methods A longitudinal study was conducted from May 2016 to June 2017 among 256 HIV infected adult patients who were enrolled at two approved treatment hospitals in Yaoundé, before the start of first-line ART. Whole blood samples were collected using standard operating procedures. HIV-loads were determined by a quantitative RealTime PCR assay. Adherence was evaluated by pharmacy refill data records. Statistical analyses were performed using the PRISM 5.0 software. Results Off the 256 HIV infected patients enrolled, 180 (70%) patients completed the study and 76 (30%) patients were lost to follow-up. The success rate in achieving viral load < 40 copies/ml was 1.8 times higher with the EFV regimen at 24 weeks and was 1.2 times higher in the NVP regimen at 48 weeks. At 48 weeks the treatment failure rate was 12.0 and 40.0% in patients on EFV and the NVP regimen, respectively. The rate of adherence varied in both ART based regimens with 84.0 to 74.0% for EFV and 65.5 to 62.5% for NVP, at 24 and 48 weeks respectively. Conclusion In our study and setting, the rate of viral load decrease was higher in the NVP based regimen than with the EFV regimen. The adherence rate to ART was higher in the EFV regimen, compared to the NVP regimen. This adds to evidence that the EFV regimen is the preferred ART combination for non-nucleoside reverse transcriptase inhibitors (NNRTIs).

Modeling the Longtiudnal Change of Viral Load of HIV&nbsp;Positive Patients on Antiretroviral Therapy

“…Cameroon (Chendi et al, 2019). This means patients with longer time on treatment have a lower viral load than those of patients with short duration on the treatment.…”

“…In Ethiopia there are no studies to the best of our knowledge that documented on the area of longitudinal change of viral load among HIV infected patient even in Africa few numbers of studies like (Chendi et al, 2019) with their massive limitations attempted to determine the trend of viral load and its associated factors after patients startedART.Lack of appropriately applied statistical modeling which accurately describes the trend of viral load on each individual patient and inability of incorporating sufficient number of predictors that can affect the trend of viral load are the main problem of those few studies. Therefore, the aim of this study wasmodeling the change of viral load and identifying its associated factors among HIV-positive patients following ART by applying advanced models that can account correlation within a patient over time since classical statistical models are not appropriate for longitudinal viral load data.…”

Suboptimal Antiretroviral Drug Levels and Virologic Failures among PLHIV at a Rural Referral Hospital in South Western Uganda: A Descriptive Cross-sectional Study.

“…Over the past four decades, there has been an unparalleled effort to provide access to antiretroviral therapy (ART) for people living with HIV (PLWH) in sub-Saharan Africa, the region with the highest HIV burden [1]. Despite the signi cant reduction in mortality among PLHIV receiving combination ART, 16% of the patients fail to achieve a sustained virological [2], and immunological response to therapy [1,3]. This could be a result of many factors including poor adherence leading to sub-optimal drug levels and viral mutations among others.…”

“…Clinic-based pill counts may be inaccurate if children or caregivers remove and throw away extra medication to appear more adherent. Moreover, patients may not remember to bring their medication containers to appointments, and bottle openings do not always re ect medication ingestion [3,5]. Achieving favorable HIV treatment outcomes is a major challenge, particularly due to non-adherence and the development of strains harboring resistance-associated mutations.…”

“…According to the WHO guidelines, virologic failure is observed when patients sustain a viral load > 1000 copies/mL after 6 to 12months of ART. The persistent high viral load in most cases is due to non-adherence [3].…”