Virological failure on first-line antiretroviral therapy; associated factors and a pragmatic approach for switching to second line therapy-evidence from a prospective cohort study in rural South-Western Uganda, 2004-2011.

Publisher: African Field Epidemiology Network Country of Publication: Uganda NLM ID: 101517926 Publication Model: eCollection Cited Medium: Internet ISSN: 1937-8688 (Electronic) NLM ISO Abbreviation: Pan Afr Med J Subsets: MEDLINE

Original Publication: Kampala, Uganda : African Field Epidemiology Network

Medication Adherence* ; Rural Population*; Anti-HIV Agents/*administration & dosage ; HIV Infections/*drug therapy; Adolescent ; Adult ; Aged ; Alcohol Drinking/epidemiology ; Cohort Studies ; Counseling ; Female ; Follow-Up Studies ; HIV Infections/virology ; Humans ; Logistic Models ; Male ; Middle Aged ; Proportional Hazards Models ; Prospective Studies ; Treatment Failure ; Uganda ; Young Adult

Introduction: We investigated factors affecting Virological failure (VF) on first line Antiretroviral Therapy (ART) and evaluated a pragmatic approach to switching to second line ART.
Methods: Between 2004 and 2011, we assessed adults taking ART. After 6 months or more on ART, participants with VL >1000 copies/ml or two successive VL > 400 copies/ml (Conventional VF) received intensified adherence counselling and continued on first-line ART for 6 more months, after which participants who still had VL > 1000 copies/ml (Pragmatic VF) were switched to second line ART. VF rates were calculated and predictors of failure were found by fitting logistic regression and Cox proportional hazards models.
Results: The 316 participants accrued 1036 person years at risk (pyar), 84 (26.6%) had conventional VF (rate 8.6 per 100 pyar) of whom 28 (33.3%) had pragmatic VF (rate 2.7 per 100 pyar). Independent predictors of conventional VF were; alcohol consumption, (adjusted Hazard Ratio; aHR = 1.71, 95% CI 1.05-2.79, P = 0.03) and ART adherence: per 10% decrease in proportion of adherent visits, (aHR = 1.83, 95% CI 1.50-2.23; P < 0.001). Using reference age group < 30 years, among conventional failures, the adjusted odds ratio (aOR) of pragmatic failure for age group 30-39 years were 0.12, 95% CI 0.03-0.57, P = 0.02 and for age group > 40 years were 0.14, 95%CI 0.03-0.71, P = 0.02. Alcohol consumers had a threefold odds of pragmatic failure than non-alcohol consumers (aOR = 3.14, 95%CI 0.95-10.34, P = 0.06).
Conclusion: A pragmatic VF approach is essential to guide switching to second line ART. Patient tailored ART adherence counselling among young patients and alcohol users is recommended.
Competing Interests: The authors declare no competing interest.

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Keywords: First line ART; conventional; pragmatic; second line ART; virological failure

0 (Anti-HIV Agents)

Date Created: 20180801 Date Completed: 20180813 Latest Revision: 20220318

20221213

PMC6061817

10.11604/pamj.2018.29.191.11940

30061969