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Differential impact of adherence on long-term treatment response among naive HIV-infected individuals.
AIDS. 2008 Nov 12; 22(17):2371-80.AIDS

Abstract

OBJECTIVES

To examine the long-term impact of adherence on virologic, immunologic, and dual response stratified by type of HAART regimen in treatment-naive patients starting HAART in British Columbia, Canada; and to assess the degree of virologic and immunologic response associated with emergence of drug resistance, progression to AIDS, and mortality.

METHODS

Eligible participants initiated HAART between 1 January 2000 and 30 November 2004, were followed until 30 November 2005, and had at least 2 years of follow-up. Virologic and immunologic responses were dichotomized at their median values. Virologic response was defined as at least 65% of follow-up time with plasma viral load (pVL) of less than 50 copies/ml. Immunologic response was defined as a CD4 cell count increase of at least 145 cells/microl. Adherence measures were based on prescription refill compliance. Proportional odds models and logistic regression were used to address our objectives.

RESULTS

The distribution of patient responses was 394 (44.9%) for CD4+/pVL+ (best), 350 (39.9%) for CD4-/pVL+ or CD4+/pVL- (incomplete), and 134 (15.3%) for CD4-/pVL- (worst). We found a positive correlation between adherence and virologic and immunologic responses (P < 0.01). Having worst compared with best response (reference group) was associated with higher odds of mortality (odds ratio: 6.09; 95% confidence interval: 2.57-14.42) and emergence of drug resistance (odds ratio: 10.56; 95% confidence interval: 5.93-18.81) even after adjusting for adherence and HAART regimen.

CONCLUSION

Patients not attaining the best virologic and immunologic responses are at a high risk for emergence of drug resistance and mortality, and these responses are highly dependent on the adherence level and initial HAART regimen. Patients on protease inhibitor-single did worse no matter the adherence level.

Authors+Show Affiliations

British Columbia Centre for Excellence in HIV/AIDS, St Paul's Hospital, Vancouver, British Columbia, Canada.No affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

18981777

Citation

Lima, Viviane D., et al. "Differential Impact of Adherence On Long-term Treatment Response Among Naive HIV-infected Individuals." AIDS (London, England), vol. 22, no. 17, 2008, pp. 2371-80.
Lima VD, Harrigan R, Murray M, et al. Differential impact of adherence on long-term treatment response among naive HIV-infected individuals. AIDS. 2008;22(17):2371-80.
Lima, V. D., Harrigan, R., Murray, M., Moore, D. M., Wood, E., Hogg, R. S., & Montaner, J. S. (2008). Differential impact of adherence on long-term treatment response among naive HIV-infected individuals. AIDS (London, England), 22(17), 2371-80. https://doi.org/10.1097/QAD.0b013e328315cdd3
Lima VD, et al. Differential Impact of Adherence On Long-term Treatment Response Among Naive HIV-infected Individuals. AIDS. 2008 Nov 12;22(17):2371-80. PubMed PMID: 18981777.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Differential impact of adherence on long-term treatment response among naive HIV-infected individuals. AU - Lima,Viviane D, AU - Harrigan,Richard, AU - Murray,Melanie, AU - Moore,David M, AU - Wood,Evan, AU - Hogg,Robert S, AU - Montaner,Julio Sg, PY - 2008/11/5/pubmed PY - 2009/2/21/medline PY - 2008/11/5/entrez SP - 2371 EP - 80 JF - AIDS (London, England) JO - AIDS VL - 22 IS - 17 N2 - OBJECTIVES: To examine the long-term impact of adherence on virologic, immunologic, and dual response stratified by type of HAART regimen in treatment-naive patients starting HAART in British Columbia, Canada; and to assess the degree of virologic and immunologic response associated with emergence of drug resistance, progression to AIDS, and mortality. METHODS: Eligible participants initiated HAART between 1 January 2000 and 30 November 2004, were followed until 30 November 2005, and had at least 2 years of follow-up. Virologic and immunologic responses were dichotomized at their median values. Virologic response was defined as at least 65% of follow-up time with plasma viral load (pVL) of less than 50 copies/ml. Immunologic response was defined as a CD4 cell count increase of at least 145 cells/microl. Adherence measures were based on prescription refill compliance. Proportional odds models and logistic regression were used to address our objectives. RESULTS: The distribution of patient responses was 394 (44.9%) for CD4+/pVL+ (best), 350 (39.9%) for CD4-/pVL+ or CD4+/pVL- (incomplete), and 134 (15.3%) for CD4-/pVL- (worst). We found a positive correlation between adherence and virologic and immunologic responses (P < 0.01). Having worst compared with best response (reference group) was associated with higher odds of mortality (odds ratio: 6.09; 95% confidence interval: 2.57-14.42) and emergence of drug resistance (odds ratio: 10.56; 95% confidence interval: 5.93-18.81) even after adjusting for adherence and HAART regimen. CONCLUSION: Patients not attaining the best virologic and immunologic responses are at a high risk for emergence of drug resistance and mortality, and these responses are highly dependent on the adherence level and initial HAART regimen. Patients on protease inhibitor-single did worse no matter the adherence level. SN - 1473-5571 UR - https://www.unboundmedicine.com/medline/citation/18981777/Differential_impact_of_adherence_on_long_term_treatment_response_among_naive_HIV_infected_individuals_ L2 - http://Insights.ovid.com/pubmed?pmid=18981777 DB - PRIME DP - Unbound Medicine ER -