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Bakri FG, Mukattash HH, Esmeiran H, Schluck G, Storme CK, Broach E, Mebrahtu T, Alhawarat M, Valencia-Ruiz A, M'Hamdi O, Malia JA, Hassen Z, Shafei MMS, Alkhatib AY, Gazo M, Jaradat SA, Gomez Y, McGeehon S, McCauley MD, Moreland SC, Darden JM, Amare M, Crowell TA, Vasan S, Michael NL, Ake JA, Modjarrad K, Scott PT, Peel SA, Hakre S. Clinical, molecular, and drug resistance epidemiology of HIV in Jordan, 2019-2021: A national study. Int J Infect Dis 2024; 145:107079. [PMID: 38697607 DOI: 10.1016/j.ijid.2024.107079] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2024] [Revised: 04/01/2024] [Accepted: 04/28/2024] [Indexed: 05/05/2024] Open
Abstract
BACKGROUND Limited epidemiologic studies have been conducted in Jordan describing the HIV epidemic. This study aimed to address this gap to inform HIV prevention and control. METHODS A nationally-representative cross-sectional study was conducted among adults living with HIV in Jordan. Laboratory testing included HIV viral load and next-generation-sequencing-based clinical genotype. Log-binomial regression estimated risk ratios (RRs) and 95% confidence intervals (CIs). RESULTS Among 231 (70%) participants, most were male (184/80%), and from Jordan (217/94%). Among 188 treatment-experienced-participants (>6 months), 165 (88%) were virally suppressed. High-level resistance was most frequent against nucleoside reverse transcriptase inhibitor (13/81%), and integrase-strand transfer inhibitor (INSTI) (10/62%) drugs among viremic (≥1000 HIV copies/mL) treatment-experienced participants with drug-resistant mutations (DRMs, n = 16). Common HIV subtypes (n = 43) were B (6/14%), A1 (5/12%), and CRF01_AE (5/12%); additionally, novel recombinant forms were detected. In multivariate analysis, independently higher risk for late diagnosis (n = 49) was observed with diagnosis through blood donation (vs check-up: RR 2.20, 95%CI 1.16-4.17) and earlier time-period of diagnosis (1986-2014 vs 2015-2021: RR 2.87, 95%CI 1.46-5.62). CONCLUSIONS Late diagnosis and INSTI resistance endanger national HIV prevention and treatment in Jordan-high-level resistance to INSTI suggests therapeutic drug monitoring is needed for treatment efficacy and conservation of treatment options.
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Affiliation(s)
- Faris G Bakri
- Division of Infectious Diseases, Department of Internal Medicine, Jordan University Hospital, Amman, Jordan; Infectious Diseases and Vaccine Center, University of Jordan, Amman, Jordan
| | | | - Hiam Esmeiran
- HJF Medical Research International (HJFMRI), Amman, Jordan
| | - Glenna Schluck
- Center for Infectious Diseases Research, Walter Reed Army Institute of Research, Silver Spring, MD; Henry M. Jackson Foundation for the Advancement of Military Medicine, Inc., Bethesda, MD
| | - Casey K Storme
- Center for Infectious Diseases Research, Walter Reed Army Institute of Research, Silver Spring, MD; Henry M. Jackson Foundation for the Advancement of Military Medicine, Inc., Bethesda, MD
| | - Erica Broach
- Center for Infectious Diseases Research, Walter Reed Army Institute of Research, Silver Spring, MD; Henry M. Jackson Foundation for the Advancement of Military Medicine, Inc., Bethesda, MD
| | - Tsedal Mebrahtu
- Center for Infectious Diseases Research, Walter Reed Army Institute of Research, Silver Spring, MD; Henry M. Jackson Foundation for the Advancement of Military Medicine, Inc., Bethesda, MD
| | | | - Anais Valencia-Ruiz
- Henry M. Jackson Foundation for the Advancement of Military Medicine, Inc., Bethesda, MD; Diagnostics and Countermeasures Branch, Walter Reed Army Institute of Research, Silver Spring, MD
| | - Oussama M'Hamdi
- Henry M. Jackson Foundation for the Advancement of Military Medicine, Inc., Bethesda, MD; Diagnostics and Countermeasures Branch, Walter Reed Army Institute of Research, Silver Spring, MD
| | - Jennifer A Malia
- Diagnostics and Countermeasures Branch, Walter Reed Army Institute of Research, Silver Spring, MD
| | - Zebiba Hassen
- Center for Infectious Diseases Research, Walter Reed Army Institute of Research, Silver Spring, MD; Henry M. Jackson Foundation for the Advancement of Military Medicine, Inc., Bethesda, MD
| | - Mah'd M S Shafei
- Central Public Health Laboratory, Ministry of Health, Amman, Jordan
| | - Ala Y Alkhatib
- Voluntary Counselling and Testing Center, Ministry of Health, Amman, Jordan
| | - Mahmoud Gazo
- Central Public Health Laboratory, Ministry of Health, Amman, Jordan
| | - Saied A Jaradat
- Princess Haya Biotechnology Center, Jordan University of Science and Technology, Irbid, Jordan
| | - Yessenia Gomez
- Center for Infectious Diseases Research, Walter Reed Army Institute of Research, Silver Spring, MD; Emerging Infectious Diseases Branch, Walter Reed Army Institute of Research, Silver Spring, MD
| | - Samantha McGeehon
- Center for Infectious Diseases Research, Walter Reed Army Institute of Research, Silver Spring, MD; Emerging Infectious Diseases Branch, Walter Reed Army Institute of Research, Silver Spring, MD
| | - Melanie D McCauley
- Center for Infectious Diseases Research, Walter Reed Army Institute of Research, Silver Spring, MD; Emerging Infectious Diseases Branch, Walter Reed Army Institute of Research, Silver Spring, MD
| | - Sarah C Moreland
- Center for Infectious Diseases Research, Walter Reed Army Institute of Research, Silver Spring, MD; Emerging Infectious Diseases Branch, Walter Reed Army Institute of Research, Silver Spring, MD
| | - Janice M Darden
- Center for Infectious Diseases Research, Walter Reed Army Institute of Research, Silver Spring, MD; Diagnostics and Countermeasures Branch, Walter Reed Army Institute of Research, Silver Spring, MD
| | - Mihret Amare
- Center for Infectious Diseases Research, Walter Reed Army Institute of Research, Silver Spring, MD; Emerging Infectious Diseases Branch, Walter Reed Army Institute of Research, Silver Spring, MD
| | - Trevor A Crowell
- Center for Infectious Diseases Research, Walter Reed Army Institute of Research, Silver Spring, MD; Henry M. Jackson Foundation for the Advancement of Military Medicine, Inc., Bethesda, MD
| | - Sandhya Vasan
- Center for Infectious Diseases Research, Walter Reed Army Institute of Research, Silver Spring, MD; Henry M. Jackson Foundation for the Advancement of Military Medicine, Inc., Bethesda, MD
| | - Nelson L Michael
- Center for Infectious Diseases Research, Walter Reed Army Institute of Research, Silver Spring, MD
| | - Julie A Ake
- United States Military HIV Research Program, Walter Reed Army Institute of Research, Silver Spring, MD
| | - Kayvon Modjarrad
- Emerging Infectious Diseases Branch, Walter Reed Army Institute of Research, Silver Spring, MD
| | - Paul T Scott
- Emerging Infectious Diseases Branch, Walter Reed Army Institute of Research, Silver Spring, MD
| | - Sheila A Peel
- Diagnostics and Countermeasures Branch, Walter Reed Army Institute of Research, Silver Spring, MD
| | - Shilpa Hakre
- Henry M. Jackson Foundation for the Advancement of Military Medicine, Inc., Bethesda, MD; Emerging Infectious Diseases Branch, Walter Reed Army Institute of Research, Silver Spring, MD.
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Shchemelev AN, Ostankova YV, Valutite DE, Serikova EN, Zueva EB, Semenov AV, Totolian AA. RISK ASSESSMENT OF FIRST-LINE TREATMENT FAILURE IN UNTREATED HIV PATIENTS IN NORTHWESTERN FEDERAL DISTRICT OF THE RUSSIAN FEDERATION. RUSSIAN JOURNAL OF INFECTION AND IMMUNITY 2023. [DOI: 10.15789/2220-7619-rao-2122] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 03/17/2023]
Abstract
The HIV infection epidemic in Russia continues to evolve, and HIV infection cases have been registered in all territorial entities of the Russian Federation. 2021 Treatment coverage was 82.2% and 56.4% individuals under dispensary observation and living with diagnosed HIV infection. 79.9% receiving ART subjects were shown to achieve undetectable viral load.
Highly active antiretroviral therapy (HAART) currently represents a combination of three (less frequently four) antiretroviral drugs targeting pathways involved in various stages of HIV replication in vivo. Treatment failure is a problem facing doctors and patients using HAART. The most common cause of therapeutic failure is the development of HIV drug resistance. The emergence of resistance is associated with processes involving mutation occurring in the viral genome influenced by evolutionary factors.
Therefore, it is important clinically and programmatically to learn more about the rate of first-line treatment failure, the rate of switching to a second-line ART regimen, and to identify patients at risk to develop strategies for preventing development of further failure cases.
The study was aimed at analyzing ineffectiveness of first-line ART therapy in patients in Northwestern Federal District of the Russian Federation.
Materials and methods
Sequencing reactions were performed using the AmpliSens HIV Resist-Seq. Assembly of consensus sequences from fragments obtained during sequencing was carried out using Unipro UGENE software. Isolate genotyping was performed using the MEGA-X software with the Neighbor-joining algorithm.
Results
The HIV pol genes in 239 patients with first-line ART failure and 100 nave patients were sequenced; all sequences genotyped as HIV-1 sub-subtype A6. According to analysis, 82% of patients had at least one significant mutation associated with drug resistance for the corresponding viral subtype. In total, we encountered 87 different drug resistance mutations.
Conclusion
We have shown increased proportion of patients with first-line ART failure among all patients with treatment failure. The main cause for such changes is probably related to the prevalence of primary drug resistance, estimated here at 8%. Specific differences were found between drug resistance mutation profiles in patients without suppressed viral load and patients with virological breakthrough. The overall results of the study indicate a need to diagnose and characterize HIV drug resistance prior to initiation of therapy in order to avoid ineffective first-line antiretroviral treatment.
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Minimal Cross-resistance to Tenofovir in Children and Adolescents Failing ART Makes Them Eligible for Tenofovir-Lamivudine-Dolutegravir Treatment. Pediatr Infect Dis J 2022; 41:827-834. [PMID: 35895893 PMCID: PMC9508940 DOI: 10.1097/inf.0000000000003647] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
BACKGROUND Fixed-dose combination of dolutegravir (DTG) with tenofovir disoproxil fumarate (TDF) and lamivudine (3TC) likely improves adherence and has a favorable resistance profile. We evaluated predicted efficacy of TLD (TDF-3TC-DTG) in children and adolescents failing abacavir (ABC), zidovudine (AZT), or TDF containing regimens. METHODS Drug resistance mutations were analyzed in a retrospective dataset of individuals <19 years of age, failing ABC (n = 293) AZT (n = 288) or TDF (n = 69) based treatment. Pol sequences were submitted to Stanford HIVdb v8.9. Genotypic susceptibility scores were calculated for various DTG-containing regimens. RESULTS Genotypes were assessed for 650 individuals with a median age of 14 years (IQR 10-17 years). More individuals failed a protease inhibitor (PI)-based (78.3%) than a non-nucleoside reverse transcriptase inhibitors (NNRTI)-based (21.7%) regimen. Most individuals in the AZT group (n = 288; 94.4%) failed a PI-based regimen, compared with 71.0% and 64.2% in the TDF (n = 69) and ABC group (n = 293). Genotypic sensitivity scores <2 to TLD were observed in 8.5% and 9.4% of ABC- and AZT-exposed individuals, compared with 23.2% in the TDF group. The M184V mutation was most often detected in the ABC group (70.6%) versus 60.0% and 52.4% in TDF and AZT groups. The presence of K65R was rare (n = 13, 2.0%) and reduced TLD susceptibility was commonly caused by accumulation of nucleoside reverse transcriptase inhibitor (NRTI) mutations. CONCLUSIONS Cross-resistance to TDF was limited, further reducing concerns about use of transition to TLD in children and adolescents. The NADIA trial has subsequently shown that patients failing a TDF/3TC/EFV regimen can safely be transitioned to a TLD regimen but we do not have data for patients failing an ABC/3TC/NNRTI or PI regimens. Frequent virological monitoring is recommended after switch to DTG, especially in children continuing ABC in the backbone. Clinical studies correlating predicted resistance with clinical outcomes, especially in settings without access to genotyping, are required.
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Tegegne AS, Muluneh MW, Agegn SB, Biresaw HB. A Comparison of Adherence and CD4 Cell Count with Respect to Virologic Failure Among HIV-Infected Adults Under Combination Antiretroviral Therapy (cART) at Felege Hiwot Teaching and Specialized Hospital, Bahir Dar, Ethiopia. HIV AIDS (Auckl) 2022; 14:33-44. [PMID: 35140523 PMCID: PMC8818763 DOI: 10.2147/hiv.s346358] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2021] [Accepted: 01/13/2022] [Indexed: 11/23/2022] Open
Abstract
Background Medication adherence plays a significant in the success of combination antiretroviral therapy (cART). Therefore, the current investigation was conducted with the objective of comparing adherence and CD4 cell count with respect to virologic failure among HIV-infected adults under cART. Methods A retrospective study design was conducted on 792 randomly selected HIV-infected adult patients who initiated first-line cART enrolled in the first 10 months of 2012 and followed up to August 2018 by using a simple random sampling technique based on their identification number. Results The main outcome for the current investigation was the virologic failure which was decreased with successive visits. The area under the receiver operating characteristic curve for adherence and CD4 cell count change were 0.68 and 0.63 with χ2 = 21.2; p-value <0.001 for the 12-month assessment. Similarly, these areas for the 36th and 60th month assessments were 0.71 and 0.66, with χ2 = 23.2; p-value <0.001, and 0.73 and 0.71 with χ2 = 24.3; p-value <0.001 for adherence and CD4 cell count, respectively. Conclusion Pill count adherence was more accurate compared to CD4 cell count change for assessing virologic responses. Therefore, because of its easy access, simple use, cost-effectiveness, and accuracy, the adherence to cART was in favor of CD4 cell count change for monitoring the healthcare quality of HIV-infected patients.
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Affiliation(s)
| | - Mitiku Wale Muluneh
- Department of Statistics, Debre Tabor University, Debre Tabor, Ethiopia
- Correspondence: Mitiku Wale Muluneh, Tel + 251-923-23-27-68, Email
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Cilento ME, Kirby KA, Sarafianos SG. Avoiding Drug Resistance in HIV Reverse Transcriptase. Chem Rev 2021; 121:3271-3296. [PMID: 33507067 DOI: 10.1021/acs.chemrev.0c00967] [Citation(s) in RCA: 41] [Impact Index Per Article: 13.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
HIV reverse transcriptase (RT) is an enzyme that plays a major role in the replication cycle of HIV and has been a key target of anti-HIV drug development efforts. Because of the high genetic diversity of the virus, mutations in RT can impart resistance to various RT inhibitors. As the prevalence of drug resistance mutations is on the rise, it is necessary to design strategies that will lead to drugs less susceptible to resistance. Here we provide an in-depth review of HIV reverse transcriptase, current RT inhibitors, novel RT inhibitors, and mechanisms of drug resistance. We also present novel strategies that can be useful to overcome RT's ability to escape therapies through drug resistance. While resistance may not be completely avoidable, designing drugs based on the strategies and principles discussed in this review could decrease the prevalence of drug resistance.
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Affiliation(s)
- Maria E Cilento
- Laboratory of Biochemical Pharmacology, Department of Pediatrics, Emory University School of Medicine, Atlanta, Georgia 30322, United States.,Children's Healthcare of Atlanta, Atlanta, Georgia 30307, United States
| | - Karen A Kirby
- Laboratory of Biochemical Pharmacology, Department of Pediatrics, Emory University School of Medicine, Atlanta, Georgia 30322, United States.,Children's Healthcare of Atlanta, Atlanta, Georgia 30307, United States
| | - Stefan G Sarafianos
- Laboratory of Biochemical Pharmacology, Department of Pediatrics, Emory University School of Medicine, Atlanta, Georgia 30322, United States.,Children's Healthcare of Atlanta, Atlanta, Georgia 30307, United States
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Teshale AB, Tsegaye AT, Wolde HF. Incidence of Mortality and Its Predictors Among HIV Positive Adults on Antiretroviral Therapy in University of Gondar Comprehensive Specialized Hospital, Northwest Ethiopia. HIV AIDS (Auckl) 2021; 13:31-39. [PMID: 33469384 PMCID: PMC7812522 DOI: 10.2147/hiv.s289794] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2020] [Accepted: 01/06/2021] [Indexed: 12/12/2022] Open
Abstract
Background Despite the accessibility and higher coverage of antiretroviral therapy (ART), HIV/AIDS is a leading cause of morbidity and mortality in low- and middle-income countries. Ethiopia also shares the high burden of HIV/AIDS-related morbidity and mortality. Therefore, this study aimed to assess the incidence of mortality and its predictors among adult HIV patients on ART in the University of Gondar Comprehensive Specialized Hospital, northwest Ethiopia. Patients and Methods A retrospective follow-up study was conducted from January 2015 to January 2019 at the University of Gondar Comprehensive Specialized Hospital. A total of 475 patients who were on follow-up in this Hospital were included. The Cox proportional hazard model was fitted to assess the predictors of mortality. Both crude and adjusted hazard ratio (AHR) with their 95% confidence interval (CI) were calculated to show the strength of association. In multivariable analysis, variables with a P-value <0.05 were considered as statistically significant predictors of mortality. Results In this study, a total of 45 (9.5%) patients died with an incidence rate of 5.3 [95% CI: 3.4–7.1] per 100 person-years of observation. In the multivariable Cox regression analysis, the last known WHO stage III/IV [AHR= 15.02; 95% CI: 5.79–38.92], being anemic at baseline [AHR = 2.21; 95% CI: 1.02–4.78], and fair last known adherence level [AHR = 3.29; 95% CI: 1.39–7.78] were found to be significant predictors of mortality. Conclusion In this study, the incidence of mortality was relatively high. The rate of mortality may be minimized by paying particular attention to individuals with advanced WHO stage, anemia at the baseline, and those with adherence problems.
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Affiliation(s)
- Achamyeleh Birhanu Teshale
- Department of Epidemiology and Biostatistics, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Adino Tesfahun Tsegaye
- Department of Epidemiology and Biostatistics, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Haileab Fekadu Wolde
- Department of Epidemiology and Biostatistics, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
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Parmley LE, Comins CA, Young K, Mcingana M, Phetlhu DR, Guddera V, Mkhize H, Hausler H, Baral S, Schwartz S. Occupational barriers to accessing and adhering to antiretroviral therapy for female sex workers living with HIV in South Africa. Occup Environ Med 2020; 77:100-106. [PMID: 31911541 DOI: 10.1136/oemed-2019-105947] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2019] [Revised: 11/04/2019] [Accepted: 12/09/2019] [Indexed: 12/25/2022]
Abstract
OBJECTIVES While female sex workers (FSW) are nearly 14 times more likely to be living with HIV than non-FSW, less than 40% of FSW living with HIV are on antiretroviral therapy (ART). We sought to understand how the work environment influences ART access and adherence for FSW in preparation for the Siyaphambili trial. METHODS FSW living with HIV (n=24) and key informants (n=15) were recruited to participate in semistructured in-depth interviews using maximum variation and snowball sampling, respectively. FSW were recruited on key variants including type of sex work venue, primary work time and history of ART use. Data were collected between September and November 2017 in Durban, South Africa. Interviews were audio-recorded, transcribed and translated. Data were then coded applying grounded theory in Atlas.ti. RESULTS FSW experienced occupational barriers to adherence including work-related migration, substance use and theft of ART on the job. Fear of wage loss due to HIV disclosure to clients and brothel managers prevented some FSW from accessing ART at their clinic and taking medications while working. FSW employed coping strategies to overcome barriers including sharing ART with colleagues, carrying small supplies of ART and visiting the clinic prior to appointments for ART refills. Further, some FSW received adherence support from colleagues who were also living with HIV. CONCLUSIONS Considering these occupational pressures on FSW and supporting positive coping strategies are important when designing and implementing HIV treatment programmes. Findings suggest strengthening social cohesion and supporting differentiated care efforts to improve HIV outcomes among FSW living with HIV.
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Affiliation(s)
- Lauren E Parmley
- ICAP, Columbia University, New York City, New York, USA .,Department of Epidemiology, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Carly A Comins
- Department of Epidemiology, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, USA
| | | | | | | | - Vijay Guddera
- Key Populations Programme, TB HIV Care, Durban, South Africa
| | | | | | - Stefan Baral
- Department of Epidemiology, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Sheree Schwartz
- Department of Epidemiology, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, USA
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Trebelcock WL, Lama JR, Duerr A, Sanchez H, Cabello R, Gilada T, Segura P, Reisner SL, Mayer KH, Mullins J, Bender Ignacio RA. HIV pretreatment drug resistance among cisgender MSM and transgender women from Lima, Peru. J Int AIDS Soc 2019; 22:e25411. [PMID: 31773888 PMCID: PMC6880186 DOI: 10.1002/jia2.25411] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2019] [Accepted: 10/16/2019] [Indexed: 12/29/2022] Open
Abstract
INTRODUCTION Transmitted, or any pretreatment drug resistance (TDR, PDR) can compromise efficacy of first-line antiretroviral therapy (ART). In Peru, genotypic resistance testing is not routinely performed before ART initiation, and estimated PDR prevalence prior to 2012 ranged from 1.0% to 4.7%. We aimed to update estimates of PDR prevalence in men who have sex with men (cis-MSM) and transgender women (TW). METHODS We obtained HIV sequences from three studies of ART-naïve cisgender-MSM and TW (n = 470) in Lima, Peru from 2013 to 2017, almost two-thirds of whom had acute or recent infections. Sanger sequences of HIV pol were interrogated for surveillance drug resistance mutations (SDRM) using the Stanford Calibrated Population Resistance (CPR) tool and scored for resistance to nucleoside reverse transcriptase inhibitors (NRTIs) and non-nucleoside reverse transcriptase inhibitors (NNRTIs) with the HIVdb programme. We calculated binomial proportions and 95% confidence intervals. χ2 and exact or trend tests were used to examine predictors of PDR. RESULTS Seventy-seven (16.4%) individuals had PDR (95% CI: 13.2 to 20.0); most resistance was likely TDR since 63% were incident infections. SDRM were present in 9.8% (7.3 to 12.9). Resistance to any NRTI was present in <1% of individuals, while efavirenz resistance was present in 10% (6.9% to 12.4%). TW were not statistically more likely than cis-MSM to have PDR (11.4% vs. 9.1%, p = 0.54). Age, incident versus prevalent infection, or residence district did not predict PDR. Prevalence of SDRM increased from 3% in 2013 to 21% 2017 within incident infections (p = 0.04), but not when including prevalent infections. CONCLUSIONS Prevalence of NNRTI resistance in three studies of ART-naïve MSM and TW in Lima, Peru reaches 10%. Because our study reports PDR in a population in which most acquired HIV recently, the overall prevalence of PDR, including previously treated persons, is likely underestimated. These results underscore the need for a nationally representative survey of PDR in Peru and consideration of non-NNRTI anchored first-line ART options. This study also represents the first evaluation of PDR in cis-MSM versus TW in South America, and demonstrates that, although TW are at higher risk of acquiring HIV, they are at similar risk of acquiring a virus with resistance mutations.
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Affiliation(s)
| | | | - Ann Duerr
- University of WashingtonSeattleWAUSA
- Fred Hutchinson Cancer Research CenterSeattleWAUSA
| | | | | | - Trupti Gilada
- Fred Hutchinson Cancer Research CenterSeattleWAUSA
- Unison Medicare and Research CentreMumbaiIndia
| | | | - Sari L Reisner
- Harvard UniversityBostonMAUSA
- The Fenway InstituteBostonMAUSA
| | - Kenneth H Mayer
- Harvard UniversityBostonMAUSA
- The Fenway InstituteBostonMAUSA
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9
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Wallis CL, Godfrey C, Fitzgibbon JE, Mellors JW. Key Factors Influencing the Emergence of Human Immunodeficiency Virus Drug Resistance in Low- and Middle-Income Countries. J Infect Dis 2017; 216:S851-S856. [PMID: 29207000 PMCID: PMC5853971 DOI: 10.1093/infdis/jix409] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
The emergence and spread of human immunodeficiency virus (HIV) drug resistance from antiretroviral roll-out programs remain a threat to long-term control of the HIV-AIDS epidemic in low- and middle-income countries (LMICs). The patterns of drug resistance and factors driving emergence of resistance are complex and multifactorial. The key drivers of drug resistance in LMICs are reviewed here, and recommendations are made to limit their influence on antiretroviral therapy efficacy.
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Affiliation(s)
- Carole L Wallis
- Bio Analytical Research Corporation-South Africa and Lancet Laboratories, Johannesburg, South Africa
| | - Catherine Godfrey
- HIV Research Branch, Therapeutics Research Program, Division of AIDS, National Institute of Allergy and Infectious Diseases, National Institutes of Health
| | - Joseph E Fitzgibbon
- Drug Development and Clinical Sciences Branch, Therapeutics Research Program, Division of AIDS, National Institute of Allergy and Infectious Diseases, National Institutes of Health
| | - John W Mellors
- HIV Research Branch, Therapeutics Research Program, Division of AIDS, National Institute of Allergy and Infectious Diseases, National Institutes of Health
- Division of Infectious Diseases, Department of Medicine, University of Pittsburgh, Pennsylvania
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Kim MJ, Lee SA, Chang HH, Kim MJ, Woo JH, Kim SI, Kang C, Kee MK, Choi JY, Choi Y, Choi BY, Kim JM, Choi JY, Kim HY, Song JY, Kim SW. Causes of HIV Drug Non-Adherence in Korea: Korea HIV/AIDS Cohort Study, 2006-2015. Infect Chemother 2017; 49:213-218. [PMID: 29027388 PMCID: PMC5620388 DOI: 10.3947/ic.2017.49.3.213] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
We aimed to determine the initial adherence of HIV cohort patients to ART (antiretroviral therapy), and reasons for non-adherence. Patients who received ART at the time of enrollment in the Korea HIV/AIDS Cohort were included in this study. Treatment adherence was determined at the baseline interview by self-reported questionnaire. Eight-hundred thirty two HIV-infected patients received ART. Of these, 253 (30.4%) patients skipped ART more than once a month. The most common reason of skipping medication was "simply forgot" (60.4%).
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Affiliation(s)
- Min Jung Kim
- Department of Internal Medicine, Kyungpook National University School of Medicine, Daegu, Korea
| | - Sang Ah Lee
- Department of Internal Medicine, Kyungpook National University School of Medicine, Daegu, Korea
| | - Hyun Ha Chang
- Department of Internal Medicine, Kyungpook National University School of Medicine, Daegu, Korea
| | - Min Ja Kim
- Division of Infectious Diseases, Department of Internal Medicine, Korea University College of Medicine, Seoul, Korea
| | - Jun Hee Woo
- Department of Infectious Diseases, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Sang Il Kim
- Division of Infectious Diseases, Department of Internal Medicine, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Chun Kang
- Division of AIDS, Korea Centers for Disease Control and Prevention, Cheongju, Korea
| | - Mee Kyung Kee
- Division of AIDS, Korea Centers for Disease Control and Prevention, Cheongju, Korea
| | - Ju Yeon Choi
- Division of AIDS, Korea Centers for Disease Control and Prevention, Cheongju, Korea
| | - Yunsu Choi
- Institute for Health and Society, Hanyang University, Seoul, Korea
| | - Bo Youl Choi
- Institute for Health and Society, Hanyang University, Seoul, Korea.,Department of Preventive Medicine, Hanyang University College of Medicine, Seoul, Korea
| | - June Myung Kim
- Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Korea.,AIDS Research Institute, Yonsei University College of Medicine, Seoul, Korea
| | - Jun Yong Choi
- Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Korea.,AIDS Research Institute, Yonsei University College of Medicine, Seoul, Korea
| | - Hyo Youl Kim
- Department of Internal Medicine, Yonsei University Wonju College of Medicine, Wonju, Korea
| | - Joon Young Song
- Department of Internal Medicine, Korea University College of Medicine, Seoul, Korea
| | - Shin Woo Kim
- Department of Internal Medicine, Kyungpook National University School of Medicine, Daegu, Korea.
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Sun L, Yang SM, Wu H, Chen B, Wang CJ, Li XF. Reliability and validity of the Chinese version of the HIV Treatment Adherence Self-Efficacy Scale in mainland China. Int J STD AIDS 2016; 28:829-837. [PMID: 27733706 DOI: 10.1177/0956462416673922] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
The aim of this study was to translate the HIV Treatment Adherence Self-Efficacy Scale (HIV-ASES) and evaluate its reliability and validity in people living with HIV (PLWHIV) in mainland China. The original HIV-ASES was translated from English into Chinese and adapted for cultural context according to cross-cultural adaptation guidelines. A cross-sectional survey investigating 1742 PLWHIV receiving antiretroviral treatment was conducted. Exploratory factor analysis with varimax rotation confirmed the presence of two factors with an accumulated contribution rate of 58.357%. Furthermore, confirmatory factor analysis revealed the model's goodness-of-fit index. The comparative fit index was greater than 0.9 and the overall efficacy of the model was satisfactory. The Cronbach α coefficient of the questionnaire was 0.876 (95% CI: 0.868-0.885), and the correlation coefficient of each item and the total was 0.536-0.660 ( P < 0.01). The Chinese version of the HIV-ASES has high reliability and validity; however, the individual item requires some adjustment.
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Affiliation(s)
- Liang Sun
- 1 Department of Social Medicine and Health Service Management, College of Public Health, Zhengzhou University, Zhengzhou, China
| | - Shu-Min Yang
- 1 Department of Social Medicine and Health Service Management, College of Public Health, Zhengzhou University, Zhengzhou, China
| | - Hui Wu
- 2 Department of General Medicine, College of Public Health, Xinxiang Medical University, Xinxiang, China
| | - Bing Chen
- 3 Sanmenxia Center for Disease Control and Prevention, Sanmenxia, China
| | - Chong-Jian Wang
- 4 Department of Epidemiology and Biostatistics, College of Public Health, Zhengzhou University, Zhengzhou, China
| | - Xiao-Fang Li
- 1 Department of Social Medicine and Health Service Management, College of Public Health, Zhengzhou University, Zhengzhou, China
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12
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Karade SK, Ghate MV, Chaturbhuj DN, Kadam DB, Shankar S, Gaikwad N, Gurav S, Joshi R, Sane SS, Kulkarni SS, Kurle SN, Paranjape RS, Rewari BB, Gangakhedkar RR. Cross-sectional study of virological failure and multinucleoside reverse transcriptase inhibitor resistance at 12 months of antiretroviral therapy in Western India. Medicine (Baltimore) 2016; 95:e4886. [PMID: 27631260 PMCID: PMC5402603 DOI: 10.1097/md.0000000000004886] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
The free antiretroviral therapy (ART) program in India has scaled up to register second largest number of people living with HIV/AIDS across the globe. To assess the effectiveness of current first-line regimen we estimated virological suppression on completion of 1 year of ART. The study describes the correlates of virological failure (VF) and multinucleoside reverse transcriptase inhibitor (NRTI) drug resistance mutations (DRMs).In this cross-sectional study conducted between June and August 2014, consecutive adults from 4 State sponsored ART clinics of western India were recruited for plasma viral load screening at 12 ± 2 months of ART initiation. Individuals with plasma viral load >1000 copies/mL were selected for HIV drug resistance (HIVDR) genotyping. Logistic regression analyses were performed to assess factors associated with VF and multi-NRTI resistance mutations. Criteria adopted for multi-NRTI resistance mutation were either presence of K65R or 3 or more thymidine analog mutations (TAMs) or presence of M184V along with 2 TAMs.Of the 844 study participants, virological suppression at 1 year was achieved in 87.7% of individuals. Factors significantly associated with VF (P < 0.005) were 12 months CD4 count of ≤100 cells/μL (adjusted OR -7.11), low reported adherence (adjusted OR -4.44), and those living without any partner (adjusted OR -1.98). In patients with VF, the prevalence of non-nucleoside reverse transcriptase inhibitor (NNRTI) DRM (78.75%) were higher as compared to NRTI (58.75%). Multi-NRTI DRMs were present in 32.5% of sequences and were significantly associated with CD4 count of ≤100 cells/μL at baseline (adjusted OR -13.00) and TDF-based failing regimen (adjusted OR -20.43). Additionally, low reported adherence was negatively associated with multi-NRTI resistance (adjusted OR -0.11, P = 0.015). K65R mutation was significantly associated with tenofovir (TDF)-based failing regimen (P < 0.001).The study supports early linkage of HIV-infected individuals to the program for ART initiation, adherence improvement, and introduction of viral load monitoring. With recent introduction of TDF-based regimen, the emergence of K65R needs to be monitored closely among HIV-1 subtype C-infected Indian population.
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Affiliation(s)
| | - Manisha V. Ghate
- Department of Clinical Sciences, National AIDS Research Institute
| | | | - Dileep B. Kadam
- Department of Medicine, BJ Medical College and Sasoon General Hospital, Pune
| | | | - Nitin Gaikwad
- Department of Tuberculosis and Chest Diseases, YCM Hospital
| | | | | | | | | | | | | | - Bharat B. Rewari
- Department of AIDS Control, National AIDS Control Organization, New Delhi, India
| | - Raman R. Gangakhedkar
- Department of Clinical Sciences, National AIDS Research Institute
- Correspondence: Raman R. Gangakhedkar, National AIDS Research Institute (ICMR), 73 G Block, MIDC Bhosari, Pune 411026, India (e-mail: )
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13
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Crouzat F, Benoit AC, Kovacs C, Smith G, Taback N, Sandler I, Acsai M, Barrie W, Brunetta J, Chang B, Fletcher D, Knox D, Merkley B, Sharma M, Tilley D, Loutfy M. Time to Viremia for Patients Taking their First Antiretroviral Regimen and the Subsequent Resistance Profiles. HIV CLINICAL TRIALS 2016; 17:1-11. [PMID: 26899538 DOI: 10.1080/15284336.2015.1111555] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
BACKGROUND The resistance profiles for patients on first-line antiretroviral therapy (ART) regimens after viremia have not been well studied in community clinic settings in the modern treatment era. OBJECTIVE To determine time to viremia and the ART resistance profiles of viremic patients. METHODS HIV-positive patients aged ≥16 years initiating a three-drug regimen were retrospectively identified from 01/01/06 to 12/31/12. The regimens were a backbone of two nucleoside reverse transcriptase inhibitors (NRTIs) and a third agent: a protease inhibitor (PI), non-nucleoside reverse transcriptase inhibitor (NNRTI), or an integrase inhibitor (II). Time to viremia was compared using a proportional hazards model, adjusting for demographic and clinical factors. Resistance profiles were described in those with baseline and follow-up genotypes. RESULTS For 653 patients, distribution of third-agent use and viremia was: 244 (37%) on PIs with 80 viremia, 364 (56%) on NNRTIs with 84 viremia, and 45 (7%) on II with 11 viremia. Only for NNRTIs, time to viremia was longer than PIs (p = 0.04) for patients with a CD4 count ≥200 cells/mm(3). Of the 175 with viremia, 143 (82%) had baseline and 37 (21%) had follow-up genotype. Upon viremia, emerging ART resistance was rare. One new NNRTI (Y181C) mutation was identified and three patients taking PI-based regimens developed NRTI mutations (M184 V, M184I, and T215Y). CONCLUSIONS Time to viremia for NNRTIs was longer than PIs. With viremia, ART resistance rarely developed without PI or II mutations, but with a few NRTI mutations in those taking PI-based regimens, and NNRTI mutations in those taking NNRTI-based regimens.
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14
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Carrico AW, Woolf-King SE, Neilands TB, Dilworth SE, Johnson MO. Stimulant use and HIV disease management among men in same-sex relationships. Drug Alcohol Depend 2014; 139:174-7. [PMID: 24726318 PMCID: PMC4048569 DOI: 10.1016/j.drugalcdep.2014.03.025] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/05/2013] [Revised: 03/18/2014] [Accepted: 03/18/2014] [Indexed: 11/18/2022]
Abstract
BACKGROUND Research conducted to date has focused primarily on identifying individual-level, psychological determinants of stimulant use and HIV disease management. The present cross-sectional study examined relationship factors as correlates of stimulant use and HIV disease management among men who have sex with men (MSM). METHODS In total, 266 male couples completed a baseline assessment for a cohort study examining the role of relationship factors in HIV treatment. A computer-based assessment of relationship factors, self-reported alcohol and substance use, and self-reported anti-retroviral therapy (ART) adherence was administered. All HIV-positive participants also provided a blood sample to measure viral load. RESULTS After controlling for demographic characteristics and relationship factors, men in a primary relationship with a stimulant-using partner had more than six-fold greater odds of reporting any stimulant use in the past three months. Among HIV-positive participants on ART (n=371), having a stimulant-using partner was independently associated with 67% lower odds of reporting perfect 30-day ART adherence and more than two-fold greater odds of displaying a detectable HIV viral load. In contrast, more partner-level alcohol use was independently associated with greater odds of reporting perfect 3-day ART adherence and lower odds of displaying a detectable HIV viral load. CONCLUSIONS Partner-level stimulant use is an important risk factor for individual-level stimulant use and difficulties with HIV disease management among MSM. To optimize the effectiveness of HIV treatment as prevention, clinical research is needed to develop couples-based interventions targeting stimulant use as a potential driver of detectable HIV viral load.
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Affiliation(s)
- Adam W Carrico
- University of California, San Francisco, School of Nursing, United States; University of California, San Francisco, Center for AIDS Prevention Studies (CAPS), United States.
| | - Sarah E Woolf-King
- University of California, San Francisco, Center for AIDS Prevention Studies (CAPS), United States
| | - Torsten B Neilands
- University of California, San Francisco, Center for AIDS Prevention Studies (CAPS), United States
| | - Samantha E Dilworth
- University of California, San Francisco, Center for AIDS Prevention Studies (CAPS), United States
| | - Mallory O Johnson
- University of California, San Francisco, School of Nursing, United States; University of California, San Francisco, Center for AIDS Prevention Studies (CAPS), United States; University of California, San Francisco, School of Pharmacy, United States
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15
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Sanguansittianant S, Nooroon N, Phaengchomduan P, Ammaranond P. Trends in prevalence of HIV-1 drug resistance in Thailand 2009-2010. J Clin Lab Anal 2014; 27:346-53. [PMID: 24038219 DOI: 10.1002/jcla.21609] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2012] [Accepted: 03/18/2013] [Indexed: 11/06/2022] Open
Abstract
BACKGROUND Treatment failure of antiretroviral therapy in HIV-1 infection is increasing due to development of viral resistance. Trends of resistance-associated mutation lead to the ineffective treatment in HIV-infected individuals. METHODS Extracted viral RNA from HIV-infected subjects in 2009 to 2010 was performed. The genotypic resistance testing was investigated for HIV-1 drug resistance in RT and PR genes. Frequencies of mutation were compared by a Fischer's exact test. RESULTS Three hundred and sixty-nine samples (147 in 2009 and 222 in 2010) were genotyped. At least one mutation was found in 90.8% (335/369) in PR gene and 87.0% (321/369) in RT gene. Three sequences in PR gene, M36I, H69K, and L90M, were decreased significantly in 2010 when compared to 2009. Mutations associated with resistance to nucleoside analogue reverse transcriptase inhibitors (NRTI's) were found in 61.0% and 64.2% in nonnucleoside analogue reverse transcriptase inhibitors (NNRTI's). A total of 49.6% was found in combined NRTI and NNRTI. In 2010, M41L was increased significantly from 7.5% to 14.9%. However, there was a decrease in the frequency of the mutations at position 67, 70, and 184 between 2009 and 2010. CONCLUSIONS In 2010, three mutations in PR gene, M36I, H69K, and L90M, were decreased significantly. However, only one mutation in RT gene, M41L was significantly increased.
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Affiliation(s)
- Sayompoo Sanguansittianant
- Graduate Program in Clinical Biochemistry and Molecular Medicine, Department of Clinical Chemistry, Faculty of Allied Health Sciences, Chulalongkorn University, Bangkok, Thailand
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16
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Woolf-King SE, Neilands TB, Dilworth SE, Carrico AW, Johnson MO. Alcohol use and HIV disease management: the impact of individual and partner-level alcohol use among HIV-positive men who have sex with men. AIDS Care 2013; 26:702-8. [PMID: 24215238 DOI: 10.1080/09540121.2013.855302] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Alcohol use among HIV-positive (HIV+) individuals is associated with decreased adherence to antiretroviral therapy (ART) and consequently poorer HIV treatment outcomes. This study examined the independent association of individual and partner-level alcohol use with HIV disease management among men who have sex with men (MSM) in primary partnerships. In total, 356 HIV+ MSM and their male primary partners completed a baseline visit for a longitudinal study examining the role of couple-level factors in HIV treatment. The Alcohol Use Disorders Identification Test (AUDIT) was administered to assess the individual and the partner-level alcohol use. Primary outcome variables included self-reported ART adherence, ART adherence self-efficacy, and HIV viral load. Results demonstrated that abstainers, compared to hazardous drinkers, had higher self-efficacy to integrate and persevere in HIV treatment and a lower odds of having a detectable viral load. Participants with a partner-abstainer, versus a partner-hazardous drinker, had less self-efficacy to persevere in HIV treatment, a lower odds of 100% three-day adherence and a higher viral load. Together, these findings suggest that assessment and treatment of both the patient's and the patient's primary partner's pattern of alcohol consumption is warranted when attempting to optimize HIV care among MSM.
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Affiliation(s)
- Sarah E Woolf-King
- a Department of Medicine, Center for AIDS Prevention Studies , University of California, San Francisco (UCSF) , San Francisco , CA , USA
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17
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Chen WT, Wantland D, Reid P, Corless IB, Eller LS, Iipinge S, Holzemer WL, Nokes K, Sefcik E, Rivero-Mendez M, Voss J, Nicholas P, Phillips JC, Brion JM, Rose CD, Portillo CJ, Kirksey K, Sullivan KM, Johnson MO, Tyer-Viola L, Webel AR. Engagement with Health Care Providers Affects Self- Efficacy, Self-Esteem, Medication Adherence and Quality of Life in People Living with HIV. JOURNAL OF AIDS & CLINICAL RESEARCH 2013; 4:256. [PMID: 24575329 PMCID: PMC3932545 DOI: 10.4172/2155-6113.1000256] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
The engagement of patients with their health care providers (HCP) improves patients' quality of life (QOL), adherence to antiretroviral therapy, and life satisfaction. Engagement with HCP includes access to HCP as needed, information sharing, involvement of client in decision making and self-care activities, respect and support of the HCP for the client's choices, and management of client concerns. This study compares country-level differences in patients' engagement with HCP and assesses statistical associations relative to adherence rates, self-efficacy, self-esteem, QOL, and symptom self-reporting by people living with HIV (PLHIV). A convenience sample of 2,182 PLHIV was enrolled in the United States, Canada, Puerto Rico, Namibia, and China. Cross-sectional data were collected between September 2009 and January 2011. Inclusion criteria were being at least 18 years of age, diagnosed with HIV, able to provide informed consent, and able to communicate in the local language with site researchers. In the HCP scale, a low score indicated greater provider engagement. Country comparisons showed that PLHIV in Namibia had the most HCP engagement (OR 2.80, p < 0.001) and that PLHIV in China had the least engagement (OR -7.03, p < 0.0001) compared to the PLHIV in the Western countries. Individuals having better HCP engagement showed better self-efficacy for adherence (t = -5.22, p < 0.0001), missed fewer medication doses (t = 1.92, p ≤ 0.05), had lower self-esteem ratings (t = 2.67, p < 0.01), fewer self-reported symptoms (t = 3.25, p < 0.0001), and better overall QOL physical condition (t = -3.39, p < 0.001). This study suggests that promoting engagement with the HCP is necessary to facilitate skills that help PLHIV manage their HIV. To improve ART adherence, HCPs should work on strategies to enhance self-efficacy and self-esteem, therefore, exhibiting fewer HIV-related symptoms and missing less medication doses to achieve better QOL.
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Affiliation(s)
- Wei-Ti Chen
- Assistant Professor,400 West Campus Dr. #22110, Orange, CT 06477, School of Nursing, Yale University, Orange, CT 06477, USA
| | - Dean Wantland
- Assistant Professor, Rutgers College of Nursing Ackerson Hall 180 University Avenue, Room 330 Newark, NJ 07102, USA
| | - Paula Reid
- Assistant Professor, University of North Carolina Wilmington (UNCW) School of Nursing 601 South College Road Wilmington, North Carolina, USA
| | - Inge B Corless
- Professor, Institute of Health Professions CNY 36 1st Avenue Boston, MA 02116, USA
| | - Lucille S. Eller
- Associate Professor, Rutgers College of Nursing 101 Glen Rock Road Cedar Grove, NJ 07009, USA
| | - Scholastika Iipinge
- Senior Lecturer University of Namibia Main Campus, Mandume Ndemufayo Avenue, Windhoek Block F, Room 204, 3rd Level Namibia
| | - William L Holzemer
- Dean and Professor Rutgers College of Nursing Ackerson Hall 180 University Avenue, Room 302C Newark, NJ, USA
| | - Kathleen Nokes
- Professor and Graduate Program Director, Hunter College, CUNY, Hunter Bellevue SON, 425 East 25 Street, Box 874, New York, NY 10010, USA
| | - Elizbeth Sefcik
- Professor Texas A&M University-Corpus Christi 6300 Ocean Dr. Island Hall, Rm 329 Corpus Christi, TX 78404, USA
| | - Marta Rivero-Mendez
- Professor University of Puerto Rico PO Box 365067 San Juan, PR 00936-5067, USA
| | - Joachim Voss
- Associate Professor University of Washington, School of Nursing PO Box 357266 Seattle, WA 98195, USA
| | - Patrice Nicholas
- Professor and Director, Global Health and Academic Partnerships Brigham and Women’s Hospital and MGH Institute of Health Professions 36 1st Avenue Boston, MA 02129, USA
| | - J. Craig Phillips
- École des Sciences Infirmières, School of Nursing Faculté des Sciences de la Santé, Faculty of Health Sciences Université d’Ottawa, University of Ottawa 451 chemin Smyth Road Ottawa, Ontario, CANADA
| | - John M. Brion
- Associate Clinical Professor, The Ohio State University College of Nursing 1585 Neil Ave. #344 Columbus, Ohio 43201, USA
| | - Caro Dawson Rose
- Associate Professor UCSF School of Nursing Dept. of Community Health Systems San Francisco, CA, USA
| | - Carmen J Portillo
- Professor and Chair UCSF, School of Nursing, 2 Koret Way San Francisco, CA 94143, USA
| | - Kenn Kirksey
- Director, Nursing Strategic Initiatives Lyndon B. Johnson Hospital, Harris Health System 5656 Kelley Street Houston, TX, USA
| | - Kathleen M Sullivan
- Associate Professor University of Hawaii School of Nursing McCarthy Mall, Webster 439 Honolulu, HI 96822, USA
| | - Mallory O Johnson
- Associate Professor UCSF 50 Beale Street, Suite 1300 San Francisco, CA 94105, USA
| | - Lynda Tyer-Viola
- Assistant Professor MGH Institute of Health Professions 3047 Bonnebridge Way Houston, TX 77082, USA
| | - Allison R Webel
- Instructor Case Western Reserve University School of Nursing Cleveland, OH 44106, USA
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18
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von Wyl V, Klimkait T, Yerly S, Nicca D, Furrer H, Cavassini M, Calmy A, Bernasconi E, Böni J, Aubert V, Günthard HF, Bucher HC, Glass TR. Adherence as a predictor of the development of class-specific resistance mutations: the Swiss HIV Cohort Study. PLoS One 2013; 8:e77691. [PMID: 24147057 PMCID: PMC3797701 DOI: 10.1371/journal.pone.0077691] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2013] [Accepted: 09/03/2013] [Indexed: 11/18/2022] Open
Abstract
Background Non-adherence is one of the strongest predictors of therapeutic failure in HIV-positive patients. Virologic failure with subsequent emergence of resistance reduces future treatment options and long-term clinical success. Methods Prospective observational cohort study including patients starting new class of antiretroviral therapy (ART) between 2003 and 2010. Participants were naïve to ART class and completed ≥1 adherence questionnaire prior to resistance testing. Outcomes were development of any IAS-USA, class-specific, or M184V mutations. Associations between adherence and resistance were estimated using logistic regression models stratified by ART class. Results Of 314 included individuals, 162 started NNRTI and 152 a PI/r regimen. Adherence was similar between groups with 85% reporting adherence ≥95%. Number of new mutations increased with increasing non-adherence. In NNRTI group, multivariable models indicated a significant linear association in odds of developing IAS-USA (odds ratio (OR) 1.66, 95% confidence interval (CI): 1.04-2.67) or class-specific (OR 1.65, 95% CI: 1.00-2.70) mutations. Levels of drug resistance were considerably lower in PI/r group and adherence was only significantly associated with M184V mutations (OR 8.38, 95% CI: 1.26-55.70). Adherence was significantly associated with HIV RNA in PI/r but not NNRTI regimens. Conclusion Therapies containing PI/r appear more forgiving to incomplete adherence compared with NNRTI regimens, which allow higher levels of resistance, even with adherence above 95%. However, in failing PI/r regimens good adherence may prevent accumulation of further resistance mutations and therefore help to preserve future drug options. In contrast, adherence levels have little impact on NNRTI treatments once the first mutations have emerged.
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Affiliation(s)
- Viktor von Wyl
- Division of Infectious Diseases and Hospital Epidemiology, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Thomas Klimkait
- Department of Biomedicine, University of Basel, Basel, Switzerland
| | - Sabine Yerly
- Laboratory of Virology, Geneva University Hospital, Geneva, Switzerland
| | - Dunja Nicca
- Division of Infectious Diseases, Cantonal Hospital St. Gallen, St. Gallen, Switzerland
| | - Hansjakob Furrer
- Department of Infectious Diseases, Bern University Hospital and University of Bern, Bern, Switzerland
| | - Matthias Cavassini
- Division of Infectious Diseases, University Hospital Lausanne, Lausanne, Switzerland
| | - Alexandra Calmy
- Division of Infectious Diseases, University Hospital Geneva, Geneva, Switzerland
| | - Enos Bernasconi
- Division of Infectious Diseases, Regional Hospital Lugano, Lugano, Switzerland
| | - Jürg Böni
- Institute of Medical Virology, Swiss National Center for Retroviruses, University of Zürich, Zürich, Switzerland
| | - Vincent Aubert
- Division of Immunology and Allergy, Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland
| | - Huldrych F. Günthard
- Division of Infectious Diseases and Hospital Epidemiology, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Heiner C. Bucher
- Basel Institute for Clinical Epidemiology and Biostatistics, University Hospital Basel, Basel, Switzerland
| | - Tracy R. Glass
- Basel Institute for Clinical Epidemiology and Biostatistics, University Hospital Basel, Basel, Switzerland
- Department of Biostatistics, Swiss Tropical and Public Health Institute, Basel, Switzerland
- * E-mail:
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19
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Phillips JC, Webel A, Rose CD, Corless IB, Sullivan KM, Voss J, Wantland D, Nokes K, Brion J, Chen WT, Iipinge S, Eller LS, Tyer-Viola L, Rivero-Méndez M, Nicholas PK, Johnson MO, Maryland M, Kemppainen J, Portillo CJ, Chaiphibalsarisdi P, Kirksey KM, Sefcik E, Reid P, Cuca Y, Huang E, Holzemer WL. Associations between the legal context of HIV, perceived social capital, and HIV antiretroviral adherence in North America. BMC Public Health 2013; 13:736. [PMID: 23924399 PMCID: PMC3750916 DOI: 10.1186/1471-2458-13-736] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2012] [Accepted: 08/06/2013] [Indexed: 12/02/2022] Open
Abstract
BACKGROUND Human rights approaches to manage HIV and efforts to decriminalize HIV exposure/transmission globally offer hope to persons living with HIV (PLWH). However, among vulnerable populations of PLWH, substantial human rights and structural challenges (disadvantage and injustice that results from everyday practices of a well-intentioned liberal society) must be addressed. These challenges span all ecosocial context levels and in North America (Canada and the United States) can include prosecution for HIV nondisclosure and HIV exposure/transmission. Our aims were to: 1) Determine if there were associations between the social structural factor of criminalization of HIV exposure/transmission, the individual factor of perceived social capital (resources to support one's life chances and overcome life's challenges), and HIV antiretroviral therapy (ART) adherence among PLWH and 2) describe the nature of associations between the social structural factor of criminalization of HIV exposure/transmission, the individual factor of perceived social capital, and HIV ART adherence among PLWH. METHODS We used ecosocial theory and social epidemiology to guide our study. HIV related criminal law data were obtained from published literature. Perceived social capital and HIV ART adherence data were collected from adult PLWH. Correlation and logistic regression were used to identify and characterize observed associations. RESULTS Among a sample of adult PLWH (n = 1873), significant positive associations were observed between perceived social capital, HIV disclosure required by law, and self-reported HIV ART adherence. We observed that PLWH who have higher levels of perceived social capital and who live in areas where HIV disclosure is required by law reported better average adherence. In contrast, PLWH who live in areas where HIV transmission/exposure is a crime reported lower 30-day medication adherence. Among our North American participants, being of older age, of White or Hispanic ancestry, and having higher perceived social capital, were significant predictors of better HIV ART adherence. CONCLUSIONS Treatment approaches offer clear advantages in controlling HIV and reducing HIV transmission at the population level. These advantages, however, will have limited benefit for adherence to treatments without also addressing the social and structural challenges that allow HIV to continue to spread among society's most vulnerable populations.
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Affiliation(s)
- J Craig Phillips
- Faculty of Health Sciences, University of Ottawa School of Nursing, 451 chemin Smyth Road, Ottawa, ON K1H 8M5, Canada
| | - Allison Webel
- Frances Payne Bolton School of Nursing, Case Western Reserve University, 10900 Euclid Avenue, Cleveland, OH 44122, USA
| | - Carol Dawson Rose
- Department of Community Health Systems, University of California School of Nursing, San Francisco, CA 94143-0608, USA
| | - Inge B Corless
- MGH Institute of Health Professions, CNY 36 1st Avenue, Boston, MA 02116, USA
| | - Kathleen M Sullivan
- University of Hawaii School of Nursing, McCarthy Mall, Webster 439, Honolulu, HI 96822, USA
| | - Joachim Voss
- University of Washington School of Nursing, Box 357266, Seattle, WA 98103, USA
| | - Dean Wantland
- Office of Research & Evaluation, Rutgers College of Nursing, Ackerson Hall, 180 University Avenue, Room 330, Newark, NJ 07102, USA
| | - Kathleen Nokes
- Hunter College, CUNY, Hunter Bellevue SON, 425 East 25 Street, Box 874, New York, NY 10010, USA
| | - John Brion
- Duke University School of Nursing, 20 West Bridlewood Trail, Durham, NC 27713, USA
| | - Wei-Ti Chen
- Yale University School of Nursing, PO Box 27399, West Haven, CT 06516-7399, USA
| | - Scholastika Iipinge
- University of Namibia Main Campus, Mandume Ndemufayo Avenue, Block F, Room 204, 3rd Level, Windhoek, Namibia
| | | | - Lynda Tyer-Viola
- MGH Institute of Health Professions, 3047 Bonnebridge Way, Houston, TX 77082, USA
| | - Marta Rivero-Méndez
- University of Puerto Rico, PO Box 365067, San Juan, PR 00936-5067, Puerto Rico
| | - Patrice K Nicholas
- Global Health and Academic Partnerships, Brigham and Women's Hospital and MGH, Institute of Health Professions, 36 1st Avenue, Boston, MA 02129, USA
| | - Mallory O Johnson
- University of California, 50 Beale Street, Suite 1300, San Francisco, CA 94105, USA
| | - Mary Maryland
- Chicago State University College of Health Sciences, Department of Nursing, 420 S. Home Avenue, Oak Park, IL 60302, USA
| | - Jeanne Kemppainen
- University of North Carolina Wilmington, 601 S. College Road, Wilmington, NC 28403, USA
| | - Carmen J Portillo
- University of California, School of Nurisng, 2 Koret Way, San Francisco, CA 94143, USA
| | | | - Kenn M Kirksey
- Nursing Strategic Initiatives, Lyndon B. Johnson Hospital – Executive Administration, Harris Health System, 5656 Kelley Street, Houston, TX 77026, USA
| | - Elizabeth Sefcik
- Texas A&M University-Corpus Christi, 6300 Ocean Dr. Island Hall, Rm 329, Corpus Christi, TX 78404, USA
| | - Paula Reid
- The University of North Carolina at Wilmington, School of Nursing, 601 College Road, Wilmington, NC 28403-5995, USA
| | - Yvette Cuca
- University of California, School of Nurisng, 2 Koret Way, San Francisco, CA 94143, USA
| | - Emily Huang
- University of California, School of Nurisng, 2 Koret Way, San Francisco, CA 94143, USA
| | - William L Holzemer
- Rutgers College of Nursing, Ackerson Hall, 180 University Avenue, Room 302C, Newark, NJ 07102, USA
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Saberi P, Neilands TB, Johnson MO. Association between Dog Guardianship and HIV Clinical Outcomes. ACTA ACUST UNITED AC 2013. [DOI: 10.1177/2325957413488832] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Despite numerous potential health outcomes of dog guardianship, their value has not been examined in the HIV-positive population. The study objective was to examine the relationship between dog guardianship and HIV clinical outcomes (antiretroviral adherence [≥95% versus <95%], HIV viral load [≥48 versus <48 copies/mL], and CD4 count) among HIV-positive individuals. The authors conducted a secondary analysis of baseline data of 370 HIV-positive men on antiretroviral regimen enrolled in the Duo Project. Generalized estimating equations were used for inferential regression analyses, while controlling for the focal dog guardianship variable and nonfocal covariates. Current dog guardianship was reported in 28.7% of participants. Dog guardianship may be associated with higher CD4 (coefficient = 60.6, P = .052) and adherence ≥95% (odds ratio [OR] = 1.80, P = .048); however, having a detectable viral load was not related to dog guardianship (OR = 0.94, P = .85). Further clinical research with detailed dog guardianship data is needed to further examine the association between dog guardianship and HIV clinical outcomes.
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Affiliation(s)
- Parya Saberi
- University of California, San Francisco, CA, USA
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Johnson MO, Rose CD, Dilworth SE, Neilands TB. Advances in the conceptualization and measurement of Health Care Empowerment: development and validation of the Health Care Empowerment inventory. PLoS One 2012; 7:e45692. [PMID: 23029184 PMCID: PMC3446922 DOI: 10.1371/journal.pone.0045692] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2012] [Accepted: 08/21/2012] [Indexed: 11/30/2022] Open
Abstract
The Health Care Empowerment Model offers direction for the investigation of patient-controlled engagement and involvement in health care. At the core of the model is the construct of Health Care Empowerment (HCE), for which there exist no validated measures. A set of 27 candidate self-report survey items was constructed to capture five hypothesized inter-related facets of HCE (informed, engaged, committed, collaborative, and tolerant of uncertainty). The full item set was administered to 644 HIV-infected persons enrolled in three ongoing research studies. Exploratory and confirmatory factor analyses resulted in a two factor solution comprising four items each on two subscales: (1) HCE: Informed, Committed, Collaborative, and Engaged HCE ICCE) and (2) HCE Tolerance of Uncertainty (HCE TU). Subscale scores were evaluated for relationships with relevant constructs measured in the three studies, including depression, provider relationships, medication adherence, and HIV-1 viral load. Findings suggest the utility of this 8-item Health Care Empowerment Inventory (HCEI) in efforts to measure, understand, and track changes in the ways in which individuals engage in health care.
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Affiliation(s)
- Mallory O Johnson
- Department of Medicine, University of California San Francisco, San Francisco, CA, USA.
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Abstract
To identify factors associated with antiretroviral therapy (ART) adherence and virologic control among HIV-positive men on ART in primary relationships, data were collected from 210 male couples (420 men). Dyadic actor-partner analyses investigated associations with three levels of adherence-related dependent variables: self-efficacy (ASE), self-reported adherence, and virologic control. Results indicated that higher patient ASE was related to his own positive beliefs about medications, higher relationship autonomy and intimacy, and fewer depressive symptoms. Fewer depressive symptoms and less relationship satisfaction in the partner were linked to higher ASE in the patient. Better self-reported adherence was related to the patient's positive appraisal of the relationship and the partner's positive treatment efficacy beliefs. Greater medication concerns of both patient and partner were associated with less adherence. The partner's higher relationship commitment was associated with lower viral load in the patient. Findings suggest that depressive symptoms, treatment beliefs, and relationship quality factors of both partners may influence adherence-related outcomes.
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Johnson MO, Sevelius JM, Dilworth SE, Saberi P, Neilands TB. Preliminary support for the construct of health care empowerment in the context of treatment for human immunodeficiency virus. Patient Prefer Adherence 2012; 6:395-404. [PMID: 22654510 PMCID: PMC3363300 DOI: 10.2147/ppa.s30040] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND The Model of Health Care Empowerment (HCE) defines HCE as the process and state of being engaged, informed, collaborative, committed, and tolerant of uncertainty regarding health care. We examined the hypothesized antecedents and clinical outcomes of this model using data from ongoing human immunodeficiency virus (HIV)-related research. The purpose of this paper is to explore whether a new measure of HCE offers direction for understanding patient engagement in HIV medical care. Using data from two ongoing trials of social and behavioral aspects of HIV treatment, we examined preliminary support for hypothesized clinical outcomes and antecedents of HCE in the context of HIV treatment. METHODS This was a cross-sectional analysis of 12-month data from study 1 (a longitudinal cohort study of male couples in which one or both partners are HIV-seropositive and taking HIV medications) and 6-month data from study 2, a randomized controlled trial of HIV-seropositive persons not on antiretroviral therapy at baseline despite meeting guidelines for treatment. From studies 1 and 2, 254 and 148 participants were included, respectively. Hypothesized antecedents included cultural/social/environmental factors (demographics, HIV-related stigma), personal resources (social problem-solving, treatment knowledge and beliefs, treatment decision-making, shared decision-making, decisional balance, assertive communication, trust in providers, personal knowledge by provider, social support), and intrapersonal factors (depressive symptoms, positive/negative affect, and perceived stress). Hypothesized clinical outcomes of HCE included primary care appointment attendance, antiretroviral therapy use, adherence self-efficacy, medication adherence, CD4+ cell count, and HIV viral load. RESULTS Although there was no association observed between HCE and HIV viral load and CD4+ cell count, there were significant positive associations of HCE scores with likelihood of reporting a recent primary care visit, greater treatment adherence self-efficacy, and higher adherence to antiretroviral therapy. Hypothesized antecedents of HCE included higher beliefs in the necessity of treatment and positive provider relationships.
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Affiliation(s)
- Mallory O Johnson
- Department of Medicine, University of California, San Francisco, CA, USA
| | - Jeanne M Sevelius
- Department of Medicine, University of California, San Francisco, CA, USA
| | | | - Parya Saberi
- Department of Medicine, University of California, San Francisco, CA, USA
| | - Torsten B Neilands
- Department of Medicine, University of California, San Francisco, CA, USA
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Duncan LG, Moskowitz JT, Neilands TB, Dilworth SE, Hecht FM, Johnson MO. Mindfulness-based stress reduction for HIV treatment side effects: a randomized, wait-list controlled trial. J Pain Symptom Manage 2012; 43:161-71. [PMID: 21925831 PMCID: PMC3253947 DOI: 10.1016/j.jpainsymman.2011.04.007] [Citation(s) in RCA: 60] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/08/2010] [Revised: 04/09/2011] [Accepted: 04/12/2011] [Indexed: 10/17/2022]
Abstract
CONTEXT Advances in antiretroviral therapy (ART) for HIV offer life-extending benefit; however, the side effects associated with ART use negatively impact quality of life and medication adherence among people living with HIV. OBJECTIVES This study tested the efficacy of Mindfulness-Based Stress Reduction (MBSR) for reducing ART symptoms and bother/distress related to ART side effects. Secondary aims were to test the impact of MBSR on medication adherence and psychological functioning. METHODS Seventy-six people living with HIV who were actively taking ART and reported distress from ART-related side effects were randomly assigned to an MBSR program or a wait-list control (WLC) standard care condition. We measured side effects, ART adherence, perceived stress, depression, positive and negative affect, and mindfulness at three time points: baseline, three-month follow-up, and six-month follow-up. Side effects and related distress were assessed separately from other symptoms. RESULTS Compared with a WLC, participants in the MBSR condition experienced a reduction in the frequency of symptoms attributable to ARTs at three months post-intervention (mean difference=0.33; 95% confidence interval [CI]=0.01, 0.66; t(132)=2.04, P=0.044) and six months post-intervention (mean difference=0.38; 95% CI=0.05, 0.71; t(132)=2.27, P=0.025). MBSR participants also experienced a reduction in distress associated with those symptoms at three months post-intervention (mean difference=0.47; 95% CI=0.003, 0.94; t(132)=1.99, P=0.048) compared with the WLC condition. CONCLUSION MBSR is a promising approach for reducing HIV treatment-related side effects.
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Affiliation(s)
- Larissa G Duncan
- Osher Center for Integrative Medicine, University of California at San Francisco School of Medicine, San Francisco, California, USA
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Ammaranond P, Sanguansittianan S. Mechanism of HIV antiretroviral drugs progress toward drug resistance. Fundam Clin Pharmacol 2011; 26:146-61. [PMID: 22118474 DOI: 10.1111/j.1472-8206.2011.01009.x] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
The rapid replication rate of HIV-1 RNA and its inherent genetic variation have led to the production of many HIV-1 variants with decreased drug susceptibility. The capacity of HIV to develop drug resistance mutations is a major obstacle to long-term effective anti-HIV therapy. Incomplete suppression of viral replication with an initial drug regimen diminishes the clinical benefit to the patient and may promote the development of broader drug resistance that may cause subsequent treatment regimens to be ineffective. The increased clinical use of combination antiretroviral treatment for HIV-1 infection has led to the selection of viral strains resistant to multiple drugs, including strains resistant to all licensed nucleoside analog RT inhibitors and protease inhibitors. Therefore, it is important to understand the influence of such mutations on viral properties such as replicative fitness, fidelity, and mutation rates. Although research continues to improve our understanding of resistance, leading to refined treatment strategies and, in some cases, improved outcome, resistance to antiretroviral therapy remains a major cause of treatment failure among patients living with HIV-1.
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Affiliation(s)
- Palanee Ammaranond
- Department of Transfusion Medicine, Faculty of Allied Health Sciences, Chulalongkorn University, Bangkok, Thailand.
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Sigaloff KCE, Calis JCJ, Geelen SP, van Vugt M, de Wit TFR. HIV-1-resistance-associated mutations after failure of first-line antiretroviral treatment among children in resource-poor regions: a systematic review. THE LANCET. INFECTIOUS DISEASES 2011; 11:769-79. [PMID: 21872531 DOI: 10.1016/s1473-3099(11)70141-4] [Citation(s) in RCA: 80] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
HIV-positive children are at high risk of drug resistance, which is of particular concern in settings where antiretroviral options are limited. In this Review we explore resistance rates and patterns among children in developing countries in whom antiretroviral treatment has failed. We did a systematic search of online databases and conference abstracts and included studies reporting HIV-1 drug resistance after failure of first-line paediatric regimens in children (<18 years) in resource-poor regions (Latin America, Africa, and Asia). We retrieved 1312 citations, of which 30 studies reporting outcomes in 3241 children were eligible. Viruses with resistance-associated mutations were isolated from 90% (95% CI 88-93%) of children. The prevalence of mutations associated with nucleoside reverse transcriptase inhibitors was 80%, with non-nucleoside reverse transcriptase inhibitors was 88%, and with protease inhibitors was 54%. Methods to prevent treatment failure, including adequate paediatric formulations and affordable salvage treatment options are urgently needed.
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Affiliation(s)
- Kim C E Sigaloff
- PharmAccess Foundation, Department of Global Health, Amsterdam Institute for Global Health and Development, Academic Medical Centre of University of Amsterdam, Amsterdam, Netherlands. k.sigaloff @pharmaccess.org
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Improving coping skills for self-management of treatment side effects can reduce antiretroviral medication nonadherence among people living with HIV. Ann Behav Med 2011; 41:83-91. [PMID: 20922510 PMCID: PMC3030747 DOI: 10.1007/s12160-010-9230-4] [Citation(s) in RCA: 54] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023] Open
Abstract
Background Human immunodeficiency virus (HIV) treatment side effects have a deleterious impact on treatment adherence, which is necessary to optimize treatment outcomes including morbidity and mortality. Purpose To examine the effect of the Balance Project intervention, a five-session, individually delivered HIV treatment side effects coping skills intervention on antiretroviral medication adherence. Methods HIV+ men and women (N = 249) on antiretroviral therapy (ART) with self-reported high levels of ART side effect distress were randomized to intervention or treatment as usual. The primary outcome was self-reported ART adherence as measured by a combined 3-day and 30-day adherence assessment. Results Intent-to-treat analyses revealed a significant difference in rates of nonadherence between intervention and control participants across the follow-up time points such that those in the intervention condition were less likely to report nonadherence. Secondary analyses revealed that intervention participants were more likely to seek information about side effects and social support in efforts to cope with side effects. Conclusions Interventions focusing on skills related to ART side-effects management show promise for improving ART adherence among persons experiencing high levels of perceived ART side effects.
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Antiretroviral medication adherence and the development of class-specific antiretroviral resistance. AIDS 2009; 23:1035-46. [PMID: 19381075 DOI: 10.1097/qad.0b013e32832ba8ec] [Citation(s) in RCA: 103] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
OBJECTIVE To assess the association between antiretroviral adherence and the development of class-specific antiretroviral medication resistance. DESIGN AND METHODS Literature and conference abstract review of studies assessing the association between adherence to antiretroviral therapy and the development of antiretroviral medication resistance. RESULTS Factors that determine class-specific adherence-resistance relationships include antiretroviral regimen potency, viral fitness or, more specifically, the interplay between the fold-change in resistance and fold-change in fitness caused by drug resistance mutations, and the genetic barrier to antiretroviral resistance. During multidrug therapy, differential drug exposure increases the likelihood of developing resistance. In addition, antiretroviral medications with higher potency and higher genetic barriers to resistance decrease the incidence of resistance for companion antiretroviral medications at all adherence levels. CONCLUSION Knowledge of class-specific adherence-resistance relationships may help clinicians and patients tailor therapy to match individual patterns of adherence in order to minimize the development of resistance at failure. In addition, this information may guide the selection of optimal drug combinations and regimen sequences to improve the durability of antiretroviral therapy.
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Thompson IR, Bidgood P, Petróczi A, Denholm-Price JCW, Fielder MD. An alternative methodology for the prediction of adherence to anti HIV treatment. AIDS Res Ther 2009; 6:9. [PMID: 19486507 PMCID: PMC2698819 DOI: 10.1186/1742-6405-6-9] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2008] [Accepted: 06/01/2009] [Indexed: 11/23/2022] Open
Abstract
Background Successful treatment of HIV-positive patients is fundamental to controlling the progression to AIDS. Causes of treatment failure are either related to drug resistance and/or insufficient drug levels in the blood. Severe side effects, coupled with the intense nature of many regimens, can lead to treatment fatigue and consequently to periodic or permanent non-adherence. Although non-adherence is a recognised problem in HIV treatment, it is still poorly detected in both clinical practice and research and often based on unreliable information such as self-reports, or in a research setting, Medication Events Monitoring System caps or prescription refill rates. To meet the need for having objective information on adherence, we propose a method using viral load and HIV genome sequence data to identify non-adherence amongst patients. Presentation of the hypothesis With non-adherence operationally defined as a sharp increase in viral load in the absence of mutation, it is hypothesised that periods of non-adherence can be identified retrospectively based on the observed relationship between changes in viral load and mutation. Testing the hypothesis Spikes in the viral load (VL) can be identified from time periods over which VL rises above the undetectable level to a point at which the VL decreases by a threshold amount. The presence of mutations can be established by comparing each sequence to a reference sequence and by comparing sequences in pairs taken sequentially in time, in order to identify changes within the sequences at or around 'treatment change events'. Observed spikes in VL measurements without mutation in the corresponding sequence data then serve as a proxy indicator of non-adherence. Implications of the hypothesis It is envisaged that the validation of the hypothesised approach will serve as a first step on the road to clinical practice. The information inferred from clinical data on adherence would be a crucially important feature of treatment prediction tools provided for practitioners to aid daily practice. In addition, distinct characteristics of biological markers routinely used to assess the state of the disease may be identified in the adherent and non-adherent groups. This latter approach would directly help clinicians to differentiate between non-responding and non-adherent patients.
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Stebbing J, Powles T, Nelson M, Bower M. Significance of variation within HIV, EBV, and KSHV subtypes. ACTA ACUST UNITED AC 2008; 5:93-102. [PMID: 16928877 DOI: 10.1177/1545109706290171] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
Since their initial transmission to humans, viruses have diversified extensively through recombination and mutation. The presence of intra- and inter-individual viral diversity influences disease progression, drug resistance, and therapy and presumably explains the conflicting results in many studies, including the failure of peptide-based vaccination strategies. Although HIV is a small RNA virus, coinfection with large DNA viruses, notably the oncogenic gamma-herpesviridae human herpesvirus-8 and Epstein Barr virus, is common. This coinfection occurs secondary to immunosuppression and shared transmission routes with high-risk predisposing behavior. In addition, all 3 of these viruses can lead to chronic infections, long periods of latency, and reactivation characterized by pain and suffering. The efficient targeting of their genetic diversity represents one of the major challenges in their control, both in prophylactic and therapeutic strategies. An understanding of diversity will help delineate whether population-specific vaccine strategies are necessary.
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Affiliation(s)
- Justin Stebbing
- Department of HIV Medicine, The Chelsea and Westminster Hospital, 369 Fulham Road, London, United Kingdom
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San Lio M, Carbini R, Germano P, Guidotti G, Mancinelli S, Magid N, Narciso P, Palombi L, Renzi E, Zimba I, Marazzi M. Evaluating Adherence to Highly Active Antiretroviral Therapy with Use of Pill Counts and Viral Load Measurement in the Drug Resources Enhancement against AIDS and Malnutrition Program in Mozambique. Clin Infect Dis 2008; 46:1609-16. [DOI: 10.1086/587659] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
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Blackard JT, Welles SL, Ackerman A, Kalia N, Cohen DE, Mayer KH. Immunological rebound after initiation of highly active antiretroviral therapy in treatment-naive patients. AIDS Res Hum Retroviruses 2008; 24:499-504. [PMID: 18373435 DOI: 10.1089/aid.2007.0099] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Large clinical trials have repeatedly proven the effectiveness of highly active antiretroviral therapy (HAART) in achieving virological suppression; however, subsequent increases in CD4 cell counts (i.e., immunological rebound) do not always follow. Thus, it remains unclear to what extent persons living with HIV/AIDS may expect significant increases in CD4 cell count upon HAART initiation, particularly outside of the highly structured environment of a clinical trial. We analyzed the patterns of CD4 and plasma viral load (PVL) change in 170 HIV-infected individuals who were ART naive and initiated HAART between 1997 and 2003. Immunological success (>50 CD4 cells/mm(3) increase) was evaluated using Kaplan-Meier survival analysis and Cox proportional hazard models. Of individuals, 80% experienced a confirmed CD4 cell count increase of >50 cells/mm(3) after HAART initiation. Multivariate analysis showed that patients with pre-HAART PVL >or=100,000 copies/ml were more likely to achieve immunological success when compared with patients with baseline PVL <10,000 copies/ml, suggesting that individuals with the highest HIV viral load levels may benefit the most from HAART initiation. Future studies of immunological rebound are warranted to further define and characterize immune responses to HAART in diverse populations in order to optimize guidelines for initiation of treatment and assessment of successful responses.
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Affiliation(s)
- Jason T. Blackard
- Division of Digestive Diseases, University of Cincinnati College of Medicine, Cincinnati, Ohio 45267
| | - Seth L. Welles
- Department of Epidemiology and Biostatistics, Drexel University School of Public Health, Philadelphia, Pennsylvania 19102
| | - Avra Ackerman
- Research and Evaluation Department, Fenway Community Health, Boston, Massachusetts 02115
| | - Nimisha Kalia
- Research and Evaluation Department, Fenway Community Health, Boston, Massachusetts 02115
| | - Daniel E. Cohen
- Research and Evaluation Department, Fenway Community Health, Boston, Massachusetts 02115
| | - Kenneth H. Mayer
- Research and Evaluation Department, Fenway Community Health, Boston, Massachusetts 02115
- Departments of Medicine and Community Health, Brown University and Miriam Hospital, Providence, Rhode Island 02912
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Johnson MO, Neilands TB. Coping with HIV treatment side effects: conceptualization, measurement, and linkages. AIDS Behav 2007; 11:575-85. [PMID: 17436074 PMCID: PMC2409452 DOI: 10.1007/s10461-007-9229-4] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2006] [Accepted: 03/15/2007] [Indexed: 10/23/2022]
Abstract
Side effects from HIV treatments impact quality of life (QOL) and adherence to care, and influence decisions about health care. The purposes of this study are to describe the development of a measure of coping with HIV treatment side effects, the SECope, and to provide support for the reliability and validity of the measure. Based in Stress and Coping Theory, the 20-item measure assesses strategies for coping with HIV treatment side effects, and includes scales of Positive Emotion Focused Coping, Social Support Seeking, Nonadherence, Information Seeking, and Taking Side Effect Medications. The factor structure was supported by exploratory and confirmatory factor analyses with two samples of HIV+ individuals on treatment (Ns = 173 and 233). The SECope has demonstrated reliability (internal consistency and test-retest), and its validity is supported through construct and criterion-referenced analyses. Nonadherence as a strategy for coping with side effects was associated with poorer provider relations, lower treatment knowledge, and higher beliefs of treatment effectiveness. Findings have the potential to inform investigations and interventions in the context of treatment of HIV disease and other medical conditions.
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Affiliation(s)
- Mallory O Johnson
- Center for AIDS Prevention Studies, Department of Medicine, University of California, San Francisco, San Francisco, CA 94105, USA.
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Johnson MO, Neilands TB, Dilworth SE, Morin SF, Remien RH, Chesney MA. The role of self-efficacy in HIV treatment adherence: validation of the HIV Treatment Adherence Self-Efficacy Scale (HIV-ASES). J Behav Med 2007; 30:359-70. [PMID: 17588200 PMCID: PMC2423379 DOI: 10.1007/s10865-007-9118-3] [Citation(s) in RCA: 221] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2007] [Accepted: 05/25/2007] [Indexed: 10/23/2022]
Abstract
Adherence to HIV treatment, including adherence to antiretroviral (ART) medication regimens, is paramount in the management of HIV. Self-efficacy for treatment adherence has been identified as an important correlate of medication adherence in the treatment of HIV and other medical conditions. This paper describes the validation of the HIV Treatment Adherence Self-Efficacy Scale (HIV-ASES) with two samples of HIV+ adults on ART. Factor analyses support subscales measuring Adherence Integration (eigenvalue=6.12) and Adherence Perseverance (eigenvalue=1.16), accounting for 61% of the variance in scale items. The HIV-ASES demonstrates robust internal consistency (rhos>.90) and 3-month (rs>.70) and 15-month (rs>.40) test-retest reliability. Concurrent validity analyses revealed relationships with psychosocial measures, ART adherence, clinical status, and healthcare utilization. Findings support the use of the HIV-ASES and provide guidance for further investigation of adherence self-efficacy in the context of treatment for HIV and other diseases.
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Affiliation(s)
- Mallory O Johnson
- Center for AIDS Prevention Studies, University of California, 50 Beale Street, Suite 1300, San Francisco, CA 94105, US.,
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35
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Krakovska O, Wahl LM. Optimal drug treatment regimens for HIV depend on adherence. J Theor Biol 2007; 246:499-509. [PMID: 17320115 DOI: 10.1016/j.jtbi.2006.12.038] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2006] [Revised: 12/21/2006] [Accepted: 12/21/2006] [Indexed: 11/18/2022]
Abstract
Drug therapies aimed at suppressing the human immunodeficiency virus (HIV) are highly effective, often reducing the viral load to below the limits of detection for years. Adherence to such antiviral regimens, however, is typically far from ideal. We have previously developed a model that predicts optimal treatment regimens by weighing drug toxicity against CD4+ T-cell counts, including the probability that drug resistance will emerge. We use this model to investigate the influence of adherence on therapy benefit. For a drug with a given half-life, we compare the effects of varying the dose amount and dose interval for different rates of adherence, and compute the optimal dose regimen for adherence between 65% and 95%. Our results suggest that for optimal treatment benefit, drug regimens should be adjusted for poor adherence, usually by increasing the dose amount and leaving the dose interval fixed. We also find that the benefit of therapy can be surprisingly robust to poor adherence, as long as the dose interval and dose amount are chosen accordingly.
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Affiliation(s)
- O Krakovska
- Department of Applied Mathematics, University of Western Ontario, London, Ont., Canada N6A 5B7.
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Taiwo BO, Murphy R. Transmitted Resistance: An Overview and Its Potential Relevance to the Management of HIV-Infected Persons in Resource-Limited Settings. ACTA ACUST UNITED AC 2007; 6:188-97. [PMID: 17473177 DOI: 10.1177/1545109707300683] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Transmitted resistance has become an important clinical problem in developed countries with long histories of antiretroviral use. In resource-limited settings, it is a foreseeable, if not insidiously emerging, issue. Any transmission route or currently approved antiretroviral drug may be involved. The clinical relevance of polymorphisms that commonly occur at sites known to be associated with resistance, and peculiarities of the non-B subtypes, are incompletely understood. Adverse clinical consequences that have been demonstrated with transmitted resistance include an increased risk of failing initial therapy and further development of resistance. Although treatment outcomes can be optimized by baseline resistance testing and virologic monitoring, these are impractical in most resource-limited settings at this time. The scale and impact of transmitted resistance can probably be reduced by comprehensive prevention and management strategies. Equally germane are epidemiological and clinical studies to extend understanding of the dynamics, clinical implications, and management of transmitted resistance.
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Affiliation(s)
- Babafemi O Taiwo
- Division of Infectious Diseases at Northwestern University Feinberg School of Medicine, Chicago, IL, USA.
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Fiscus SA, Kovacs A, Petch LA, Hu C, Wiznia AA, Mofenson LM, Yogev R, McIntosh K, Pelton SI, Napravnik S, Stanley K, Nachman SA. Baseline resistance to nucleoside reverse transcriptase inhibitors fails to predict virologic response to combination therapy in children (PACTG 338). AIDS Res Ther 2007; 4:2. [PMID: 17280617 PMCID: PMC1802955 DOI: 10.1186/1742-6405-4-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2006] [Accepted: 02/06/2007] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND The association between baseline drug resistance mutations and subsequent increase in viral failure has not been established for HIV-infected children. We evaluated drug resistance mutations at 39 codon sites (21 protease inhibitor (PI) resistant codons and 18 nucleoside reverse transcriptase inhibitor (NRTI) resistant codons) for 92 clinically stable NRTI-experienced, PI-naive HIV-infected children 2 to 17 years of age who were initiating new therapy with ritonavir plus zidovudine (ZDV) and lamivudine or plus stavudine. The association between baseline drug resistance mutations and subsequent viral failure after 12 and 24 weeks of highly active antiretroviral therapy (HAART) was studied. RESULTS There were few primary PI associated mutations in this PI-naïve population, but 84% had NRTI mutations--codons 215 (66%), 41 (42%), 67 (37%), 210 (33%) and 70 (32%). None of the specific baseline drug resistance mutations were associated with a higher rate of virologic failure after 12 or 24 weeks of HAART. Median week 12 viral load decreased as the total number of NRTI mutations at baseline increased (P = 0.006). Specifically, a higher level of baseline ZDV resistance mutation was associated with a decrease in viral failure after 12 weeks on a ZDV-containing HAART regimen (P = 0.017). CONCLUSION No increase was seen in the rate of viral failure after HAART associated with the presence of resistance mutations at baseline. This paradoxical result may be due to adherence, replicative capacity, or ZDV hypersusceptibility to the new regimen.
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Affiliation(s)
- Susan A Fiscus
- Department of Microbiology and Immunology, University of North Carolina School of Medicine, Chapel Hill, NC, USA
- Center for AIDS Research, University of North Carolina, Chapel Hill, NC, USA
| | - Andrea Kovacs
- Maternal, Child and Adolescent Program, University of Southern California Medical Center, Los Angeles, CA, USA
| | - Leslie A Petch
- Center for AIDS Research, University of North Carolina, Chapel Hill, NC, USA
| | - Chengcheng Hu
- Center for Biostatistics in AIDS Research and Department of Biostatistics, Harvard School of Public Health, Boston, MA, USA
| | - Andrew A Wiznia
- Department of Pediatrics, Jacobi Medical Center and Albert Einstein College of Medicine, Bronx, NY, USA
| | - Lynne M Mofenson
- Pediatric, Adolescent and Maternal AIDS Branch, National Institute of Child Health and Human Development, National Institutes of Health, Rockville, MD, USA
| | - Ram Yogev
- Division of Infectious Diseases, Children's Memorial Hospital and Northwestern University School of Medicine, Chicago, IL, USA
| | - Kenneth McIntosh
- Division of Infectious Diseases, Children's Hospital and Harvard Medical School, Boston, MA, USA
| | - Stephen I Pelton
- Department of Pediatrics, Boston Medical Center, Boston, MA, USA
| | - Sonia Napravnik
- Center for AIDS Research, University of North Carolina, Chapel Hill, NC, USA
| | - Kenneth Stanley
- Center for Biostatistics in AIDS Research and Department of Biostatistics, Harvard School of Public Health, Boston, MA, USA
| | - Sharon A Nachman
- Department of Pediatrics, SUNY Health Science Center at Stony Brook, Stony Brook, NY, USA
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38
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Adherence to HIV treatment among IDUs and the role of opioid substitution treatment (OST). THE INTERNATIONAL JOURNAL OF DRUG POLICY 2007; 18:262-70. [PMID: 17689374 DOI: 10.1016/j.drugpo.2006.12.014] [Citation(s) in RCA: 100] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2006] [Revised: 10/19/2006] [Accepted: 12/06/2006] [Indexed: 11/25/2022]
Abstract
In the era of highly effective anti-retroviral therapy (ART), data show a significant difference in treatment outcomes between injecting drug users (IDUs) and non-IDUs. Factors that may contribute to suboptimal treatment outcomes in IDUs include delayed access to ART, competing comorbid diseases, psychosocial barriers and poor long-term adherence to ART. This review describes and compares several studies on adherence to ART and its correlates in HIV-infected individuals in general, then IDUs and finally those IDUs on opioid substitution treatment (OST). It highlights how ongoing drug use or OST can modify the pattern of these correlates. The aim is to extend all the experience acquired from these studies in order to optimise both access to care and adherence in those countries where HIV infection is mainly driven by IDUs and where ART and OST are only starting to be scaled up. The role of OST in fostering access to care and adherence to ART together with the promising results achieved to date using modified directly observed therapy (DOT) programs for patients taking methadone, allow us to emphasize the efficacy of a comprehensive care model which integrates substance dependence treatment, psychiatric treatment, social services, and medical treatment. The review concludes by suggesting areas of future research targeted at improving the understanding of both the role of perceived toxicity and patient-provider relationship for patients on ART and OST.
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Remien RH, Stirratt MJ, Dognin J, Day E, El-Bassel N, Warne P. Moving From Theory to Research to Practice. J Acquir Immune Defic Syndr 2006; 43 Suppl 1:S69-78. [PMID: 17133206 DOI: 10.1097/01.qai.0000248340.20685.7d] [Citation(s) in RCA: 40] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
There is a dearth of evidence on the relative efficacy of intervention modalities to improve and maintain patient adherence to antiretroviral medications. Although empiric findings from research on HIV/AIDS, other diseases, and chronic medical conditions consistently demonstrate that social support plays an important role in facilitating adherence, few HIV/AIDS interventions have directly targeted this factor. Ewart's social action theory emphasizes the role of social relationships in behavior change and provides a comprehensive and useful guide to the development of interventions for adherence. We describe the development, content, and testing of SMART Couples, an effective antiretroviral adherence intervention that is grounded in social action theory and designed to enhance social support for ART adherence. Finally, we discuss some of the challenges of translating findings from the randomized clinical trial of this intervention into clinical practice and offer recommendations for integration of lessons learned into ongoing clinical care.
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Affiliation(s)
- Robert H Remien
- HIV Center for Clinical and Behavioral Studies, New York State Psychiatric Institute and Columbia University New York, NY 10032, USA.
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40
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Honda M, Oka S. Current therapy for human immunodeficiency virus infection and acquired immunodeficiency syndrome. Int J Hematol 2006; 84:18-22. [PMID: 16867897 DOI: 10.1532/ijh97.06102] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Antiretroviral treatments with highly active antiretroviral therapy (HAART) have shown remarkable progress in the past decade and resulted in impressive improvements in life expectancy and quality of life for patients infected with human immunodeficiency virus 1 (HIV-1). Despite the clinical benefits, the management of HIV infection faces many problems. Although HAART is able to suppress the viral load in the plasma, it is unable to eradicate it, and once HAART is initiated, treatment needs to be continued over a lifetime. The side effects of long-term HAART, such as lipodystrophy, lactic acidosis, insulin resistance, and hyperlipidemia, are negative impacts for patients who receive HAART. In addition, patients need to demonstrate high adherence to the therapy to achieve viral suppression and prevent the development of a drug-resistant virus. This review discusses currently recommended antiretroviral treatment strategies, the difficulties with antiretroviral treatments, and current issues regarding HIV management.
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Affiliation(s)
- Miwako Honda
- International Medical Center of Japan, Tokyo, Japan.
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41
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Pozniak A. Initiation of antiretroviral therapy. Curr Opin HIV AIDS 2006; 1:398-408. [PMID: 19372839 DOI: 10.1097/01.coh.0000239852.22614.b1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Abstract
PURPOSE OF REVIEW Until there is a therapy or a vaccine that can eradicate HIV infection, it is important to continue debating the issues of when and how to use the many antiviral agents licensed as initial treatment since there remain many areas of uncertainty. RECENT FINDINGS Early initiation of treatment may be beneficial in terms of HIV progression but it has to be weighed against the risks of adverse drug side effects and complications. In first-line treatment the choice of nucleoside backbones has become limited due to the availability of once a day combined formulations which have excellent short and long-term side-effect profiles. Whether to use protease inhibitors or nonnucleosides as initial agents still awaits definitive data, but again once a day therapy appears to be the preferred option. SUMMARY There are only a few initial treatment regimens which are convenient and well tolerated. Starting treatment early will only become a possibility if the agents used cause no long-term problems and no significant resistance. New agents are emerging but it is unlikely that they will manage to reach these exacting standards. There is a need for authoritative adherence research with the results being translated into general care.
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Affiliation(s)
- Anton Pozniak
- Chelsea and Westminster NHS Healthcare Trust, London SW10 9NH, UK.
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42
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Lamiraud K, Moatti JP. Economic implications of nonadherence to highly active antiretroviral treatment in HIV patients. Expert Opin Pharmacother 2006; 7:135-43. [PMID: 16433579 DOI: 10.1517/14656566.7.2.135] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Until now, the economic implications of nonadherence to drug therapies have been mostly assessed in a cost perspective and understood as the impact of nonadherence behaviours on the cost-effectiveness ratios of particular therapies. In HIV disease, some modelling approaches have suggested that high adherence levels might improve the cost-effectiveness of highly active antiretroviral treatment regimens. However, there is an urgent need for research directly observing and measuring the costs of nonadherence behaviours. In addition to this cost perspective, the authors argue that the economic impact of nonadherence should also be studied in a microeconomic--patient-oriented--perspective. Major implications of this microeconomic perspective are drawn. First, the microeconomic approach highlights that nonadherence may often be a rational choice of the patient, thus suggesting new ways for improving adherence. Second, it implies that the adherence behaviour can be interpreted as an indicator of patients' subjective valuation of highly active antiretroviral treatment therapies; in particular, higher levels of adherence are associated with higher patient well-being. Third, it shows that the adherence behaviour cannot be regarded as an exogenous variable when the impact of adherence on health outcome or on cost-effectiveness ratios is studied, thus requiring the use of specific statistical or econometric methods.
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Affiliation(s)
- Karine Lamiraud
- University of Lausanne, DEEP-HEC, Institute of Health Economics and Management, Bâtiment Internef, Quartier Unil-Dorigny, CH 1015 Lausanne, Switzerland.
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43
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Bangsberg DR, Acosta EP, Gupta R, Guzman D, Riley ED, Harrigan PR, Parkin N, Deeks SG. Adherence-resistance relationships for protease and non-nucleoside reverse transcriptase inhibitors explained by virological fitness. AIDS 2006; 20:223-31. [PMID: 16511415 DOI: 10.1097/01.aids.0000199825.34241.49] [Citation(s) in RCA: 245] [Impact Index Per Article: 13.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE To compare the prevalence of resistance by adherence level in patients treated with non-nucleoside reverse transcriptase inhibitors (NNRTI) or protease inhibitors (PI). Also to examine the mechanism of differential class-specific adherence-resistance relationships, focusing on the patient-derived capacity of wild-type and drug-resistant recombinant variants to replicate in vitro in the presence of variable drug levels. METHODS Participants received unannounced pill count measures to assess adherence, viral load monitoring, and genotypic resistance testing. The replicative capacity of drug-susceptible and drug-resistant recombinants was determined using a single-cycle recombinant phenotypic susceptibility assay. Drug exposure was estimated using population-averaged pharmacological measurements adjusted by participant-specific levels of adherence. RESULTS In the NNRTI-treated group, 69% had resistance at 0-48% adherence compared to 13% at 95-100% (P = 0.01). PI resistance was less common than NNRTI resistance at 0-48% adherence (69% versus 23%; P = 0.01). In multivariate analysis, the odds for PI resistance increased (P = 0.03) while the odds for NNRTI resistance decreased (P = 0.04) with improving adherence. Individuals with drug-resistant variants were more likely to have levels of drug exposure where the resistant variant was more fit than the drug-susceptible variant in vitro, while those with drug-susceptible virus were more likely to have levels of drug exposure where the drug-susceptible virus was more fit than the drug-resistant variant (P = 0.005). CONCLUSIONS NNRTI resistance was more common than PI resistance at low levels of adherence. Class-specific adherence-resistance relationships are associated with the relative replicative capacity of drug-resistant versus wild-type variants to replicate in the presence of clinically relevant drug levels.
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Affiliation(s)
- David R Bangsberg
- Epidemiology and Prevention Interventions Center, Division of Infectious Diseases, San Francisco General Hospital, UCSF, San Francisco, California 94143-1372, USA.
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44
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Fletcher CV, Testa MA, Brundage RC, Chesney MA, Haubrich R, Acosta EP, Martinez A, Jiang H, Gulick RM. Four measures of antiretroviral medication adherence and virologic response in AIDS clinical trials group study 359. J Acquir Immune Defic Syndr 2005; 40:301-6. [PMID: 16249704 DOI: 10.1097/01.qai.0000180078.53321.6a] [Citation(s) in RCA: 41] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
AIDS Clinical Trials Group (ACTG) 359 was a randomized, partially double-blinded factorial study of 6 antiretroviral regimens, all including saquinavir, among HIV-infected persons in whom prior therapy had failed (n = 258). Counts of remaining saquinavir capsules were determined between weeks 0 and 4; at weeks 4, 8, and 16, self-reported adherence was estimated from 2-day report of doses skipped, therapeutic coverage, and percent of doses taken were determined by electronic monitoring devices applied to saquinavir bottles, and the saquinavir 24-hour area under the curve (AUC) was estimated. Relationships were evaluated among these 4 adherence measures and the primary endpoint of week 16 HIV RNA change. Thirty percent of 254 subjects had HIV RNA < or =500 copies/mL at week 16. Only self-reported adherence and saquinavir AUC were significantly associated with week 16 HIV RNA change (P = 0.019 and 0.023, respectively), and these measures were higher in subjects with week 16 HIV RNA < or =500 copies/mL (P = 0.03 and 0.008, respectively). The ability to detect a correlation between electronically monitored adherence and virologic response was limited by the small sample size. Self-reported adherence and saquinavir AUC were significant predictors of virologic response, in this evaluation. These findings provide insight into methods of assessing and improving adherence to antiretroviral regimens.
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Affiliation(s)
- Courtney V Fletcher
- Department of Clinical Pharmacy, University of Colorado Health Sciences Center, Denver, CO 80262, USA.
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45
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Napravnik S, Edwards D, Stewart P, Stalzer B, Matteson E, Eron JJ. HIV-1 drug resistance evolution among patients on potent combination antiretroviral therapy with detectable viremia. J Acquir Immune Defic Syndr 2005; 40:34-40. [PMID: 16123679 DOI: 10.1097/01.qai.0000174929.87015.d6] [Citation(s) in RCA: 59] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Many patients infected with HIV do not achieve or maintain virologic suppression below levels of detection while on potent combination antiretroviral therapy. The likelihood of emergence of incident mutations conferring reduced antiretroviral drug susceptibility was estimated among patients maintained on a stable regimen with ongoing detectable plasma HIV RNA levels. Ninety-eight HIV-infected patients were identified who had 2 genotypic antiretroviral resistance tests available. Poisson log-linear regression models were used to identify predictors and estimate incidence rates of number of acquired antiretroviral drug resistance mutations per person-year. At the 1st resistance test, 88% of patients had evidence of at least 1 mutation. Sixty percent of patients acquired at least 1 new mutation during a median of 9.3 months between consecutive resistance tests, with an incidence rate of 1.61 acquired mutations per person-year (95% CI: 1.36-1.90). Predictors of resistance evolution included average plasma HIV RNA level, HIV RNA slope, and number of mutations detected at the 1st resistance test. The likelihood of acquiring drug resistance mutations while remaining on potent combination antiretroviral therapy that does not confer complete suppression of HIV replication is relatively low and depends on the level of viral replication and prior resistance.
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Affiliation(s)
- Sonia Napravnik
- School of Medicine, Division of Infectious Diseases, University of North Carolina at Chapel Hill, 27599, USA.
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46
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Jacobson LP, Phair JP, Yamashita TE. Virologic and immunologic response to highly active antiretroviral therapy. Curr HIV/AIDS Rep 2005; 1:74-81. [PMID: 16091226 DOI: 10.1007/s11904-004-0011-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Highly active antiretroviral therapy (HAART) delays clinical progression by suppressing viral replication, measured by a substantial reduction in HIV RNA, allowing the immune system to reconstitute, measured in most studies by an increase in CD4 cells. These virologic and immunologic consequences do not occur uniformly among HAART users. Markers of HIV disease stage at the time of HAART initiation are critical determinants of the progression while receiving HAART. In this report, we review studies describing the heterogeneous virologic and immunologic progression after the initiation of HAART, discuss methodologic concerns in the study of the response of biomarkers, and update findings obtained in the Multicenter AIDS Cohort Study, which show that CD4 cell count, history of antiretroviral therapy, and age at the time of initiation are independent determinants of response.
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Affiliation(s)
- Lisa P Jacobson
- Department of Epidemiology, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD 21205, USA.
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47
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Gazzard B. British HIV Association (BHIVA) guidelines for the treatment of HIV-infected adults with antiretroviral therapy (2005). HIV Med 2005; 6 Suppl 2:1-61. [PMID: 16011536 DOI: 10.1111/j.1468-1293.2005.0311b.x] [Citation(s) in RCA: 96] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Affiliation(s)
- B Gazzard
- Chelsea and Westimnster Hospital, London, UK.
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48
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Remien RH, Stirratt MJ, Dolezal C, Dognin JS, Wagner GJ, Carballo-Dieguez A, El-Bassel N, Jung TM. Couple-focused support to improve HIV medication adherence: a randomized controlled trial. AIDS 2005; 19:807-14. [PMID: 15867495 DOI: 10.1097/01.aids.0000168975.44219.45] [Citation(s) in RCA: 187] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE To assess the efficacy of a couple-based intervention to improve medication-taking behavior in a clinic population with demonstrated adherence problems. DESIGN A randomized controlled trial (SMART Couples Study) conducted between August 2000 and January 2004. SETTING Two HIV/AIDS outpatient clinics in New York City. PARTICIPANTS Heterosexual and homosexual HIV-serodiscordant couples (n = 215) in which the HIV-seropositive partner had < 80% adherence at baseline. The sample was predominantly lower-income racial/ethnic minorities. INTERVENTION Participants were randomly assigned to a four-session couple-focused adherence intervention or usual care. The intervention consisted of education about treatment and adherence, identifying adherence barriers, developing communication and problem-solving strategies, optimizing partner support, and building confidence for optimal adherence. OUTCOME MEASURES Medication adherence at week 8 (2 weeks after the intervention) compared with baseline, assessed with a Medication Event Monitoring System cap. RESULTS Intervention participants showed higher mean medication adherence at post-intervention when compared with controls whether adherence was defined as proportion of prescribed doses taken (76% versus 60%) or doses taken within specified time parameters (58% versus 35%). Also, participants in the intervention arm were significantly more likely to achieve high levels of adherence (> 80%, > 90%, or > 95%) when compared with controls. However, in most cases, effects diminished with time, as seen at follow-up at 3 and 6 months. CONCLUSION The SMART Couples program significantly improved medication adherence over usual care, although the level of improved adherence, for many participants, was still suboptimal and the effect was attenuated over time.
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Affiliation(s)
- Robert H Remien
- HIV Center for Clinical and Behavioral Studies, New York State Psychiatric Institute and Columbia University, New York 10032, USA.
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49
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Lucas GM. Antiretroviral adherence, drug resistance, viral fitness and HIV disease progression: a tangled web is woven. J Antimicrob Chemother 2005; 55:413-6. [PMID: 15722389 DOI: 10.1093/jac/dki042] [Citation(s) in RCA: 89] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
The clinical goals of HIV treatment are optimally accomplished through consistent high-level adherence to highly active antiretroviral therapy (HAART) and durable suppression of the viral load. However, as a result of the need for lifelong therapy and HIV's prodigious replication rate and error-prone reverse transcriptase, varying amounts of antiretroviral drug resistance are common in treated individuals. Medication adherence is linked to the development of drug resistance, although not by a simple linear relationship. Recent studies have suggested that extensive drug resistance is not a major determinant of HIV disease progression and death. Rather, failure to access care and discontinuation of or non-adherence with therapy are arguably the most important factors associated with HIV disease progression in the HAART era. Other data indicate that continued therapy in the setting of extensive drug resistance and the inability to achieve viral suppression can provide continued clinical benefit. Such benefit may be mediated, at least partially, by reductions in viral fitness associated with drug resistance mutations.
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50
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Lucas GM, Wu AW, Cheever LW. Adherence to antiretroviral therapy: An update of current concepts. Curr HIV/AIDS Rep 2004; 1:172-80. [PMID: 16091239 DOI: 10.1007/s11904-004-0027-6] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
The remarkable effectiveness of combination antiretroviral therapy (CART) in the treatment of HIV infection has placed a high premium on long-term adherence to therapy. Adherence levels to CART among HIV-infected individuals are similar to adherence levels with chronic medical conditions, such as diabetes and hypertension. However, unlike chronic medical conditions, medication adherence that is insufficient to maintain suppression of HIV replication will lead to drug resistance. Combination antiretroviral therapy regimen complexity and side-effect burden are clearly linked to adherence and are likely to be the factors most amenable to intervention. Adherence interventions that are multifaceted, flexible, and protracted are the most likely to be successful. Owing to the great benefits of CART even the small to modest gains in adherence that are achievable with adherence programs may prove to be cost effective.
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Affiliation(s)
- Gregory M Lucas
- Johns Hopkins Medical Institutions, 1830 E. Monument Street, Room 421, Baltimore, MD 21287, USA.
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