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Publication Details
AFRICAN RESEARCH NEXUS
SHINING A SPOTLIGHT ON AFRICAN RESEARCH
Treatment interruptions predict resistance in HIV-positive individuals purchasing fixed-dose combination antiretroviral therapy in Kampala, Uganda
AIDS, Volume 21, No. 8, Year 2007
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Description
OBJECTIVE: To evaluate adherence, treatment interruptions, and outcomes in patients purchasing antiretroviral fixed-dose combination (FDC) therapy. DESIGN: Ninety-seven participants were recruited into a prospective 24-week observational cohort study of HIV-positive, antiretroviral-naive individuals initiating self-pay Triomune or Maxivir therapy in Kampala, Uganda. Adherence was measured by monthly structured interview, unannounced home pill count, and electronic medication monitors (EMM). Treatment interruptions were measured as continuous intervals greater than 48 h without opening the EMM. The primary outcomes were survival with viral suppression below 400 copies/ml, CD4 cell increases, and genotypic drug resistance at 24 weeks. RESULTS: The median baseline CD4 cell count was 56 cells/μl and median log10 copies RNA/ml was 5.54; mean adherence ranged from 82 to 95% for all measures but declined significantly over time. In an intent-to-treat analysis, 70 (72%) patients had an undetectable plasma HIV-RNA level at week 24. Sixty-two of 95 (65%) individuals with continuous EMM data had a treatment interruption of greater than 48 h. Treatment interruptions accounted for 90% of missed doses. None of 33 participants who did not interrupt treatment for over 48 h had drug resistance, whereas eight of 62 (13%) participants who did interrupt therapy experienced drug resistance. Antiretroviral resistance was seen in 8% of individuals and overall mortality was 10% at 24 weeks. CONCLUSION: HIV-positive individuals purchasing generic FDC antiretroviral therapy have high rates of adherence and viral suppression, low rates of antiretroviral resistance, and robust CD4 cell responses. Adherence is an important predictor of survival with full viral suppression. Treatment interruptions are an important predictor of drug resistance. © 2007 Lippincott Williams & Wilkins, Inc.
Authors & Co-Authors
Oyugi, Jessica H.
Uganda, Kampala
Infectious Diseases Institute
Byakika-Tusiime, Jayne
Uganda, Kampala
Makerere University
Ragland, Kathleen
United States, Baltimore
Epidemiology and Prevention Interventions Center
Laeyendecker, Oliver B.
United States, Baltimore
Johns Hopkins University
Mugerwa, Roy D.
Uganda, Kampala
Makerere University
Kityo, Cissy Mutuluuza
Uganda, Kampala
Joint Clinical Research Center Uganda
Mugyenyi, Peter N.
Uganda, Kampala
Joint Clinical Research Center Uganda
Quinn, Thomas Charles
United States, Baltimore
Johns Hopkins University
Bangsberg, David R.
United States, Baltimore
Epidemiology and Prevention Interventions Center
United States, San Francisco
University of California, San Francisco
Statistics
Citations: 295
Authors: 9
Affiliations: 6
Identifiers
Doi:
10.1097/QAD.0b013e32802e6bfa
Research Areas
Infectious Diseases
Study Design
Cohort Study
Study Approach
Quantitative
Study Locations
Uganda