Journal
AIDS RESEARCH AND HUMAN RETROVIRUSES
Volume 24, Issue 8, Pages 1031-1035Publisher
MARY ANN LIEBERT, INC
DOI: 10.1089/aid.2008.0035
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Funding
- Fogarty International Clinical Research Scholars Program [D43 TW001035, R24 TW007988]
- National Institutes of Health [K23 AI01411, K01 TW06670]
- University of Alabama at Birmingham Center for AIDS Research [P30 AI27767-20]
- Doris Duke Clinical Scientist Development Award [2007061]
- U.S. Centers for Disease Control and Prevention [U62/CCU12354]
- Doris Duke Charitable Foundation [2005047]
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We evaluated the association between two antiretroviral therapy (ART) adherence measurements-the medication possession ratio (MPR) and patient self-report-and detectable HIV viremia in the setting of rapid service scale-up in Lusaka, Zambia. Drug adherence and outcomes were assessed in a subset of patients suspected of treatment failure based on discordant clinical and immunologic responses to ART. A total of 913 patients were included in this analysis, with a median time of 744 days (Q1, Q3: 511, 919 days) from ART initiation to viral load (VL) measurement. On aggregate over the period of follow-up, 531 (58%) had optimal adherence (MPR >= 95%), 306 (34%) had suboptimal adherence (MPR 80-94%), and 76 (8%) had poor adherence (MPR <80%). Of the 913 patients, 238 (26%) had VL >= 400 copies/ml when tested. When compared to individuals with optimal adherence, there was increasing risk for virologic failure in those with suboptimal adherence [ adjusted relative risk (ARR): 1.3; 95% confidence interval (CI): 1.0, 1.6] and those with poor adherence (ARR: 1.7; 95% CI: 1.3, 2.4) based on MPR. During the antiretroviral treatment course, 676 patients (74%) reported no missed doses. The proportion of patients with virologic failure did not differ significantly among those reporting any missed dose from those reporting perfect adherence (26% vs. 26%, p = 0.97). Among patients with suspected treatment failure, a lower MPR was associated with higher rates of detectable viremia. However, the suboptimal sensitivity and specificity of MPR limit its utility as a sole predictor of virologic failure.
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