Early Warning Indicators for First-Line Virologic Failure Independent of Adherence Measures in a South African Urban Clinic

• Type of Material: Article
• Authors: Vincent Marconi, Emory University; Baohua Wu, Emory University; Jane Hampton, McCord Hospital; Claudia E. Ordóñez, McCord Hospital; Brent Johnson, Emory University; Dinesh Singh, McCord Hospital; Sally John, McCord Hospital; Michelle Gordon, Nelson Mandela School of Medicine; Anna Hare, Emory University; Richard Murphy, Doctors Without Borders; Jean Nachega, Pittsburgh University; Daniel R. Kuritzkes, Brigham and Women's Hospital; Carlos Del Rio, Emory University; Henry Sunpath, McCord Hospital
• Language: English
• Date: 2013-12-01
• Publisher: Mary Ann Liebert
• Publication Version: Final Published Version
• Copyright Statement: ©2013, Mary Ann Liebert, Inc.
• License: Creative Commons Attribution 4.0 International
• Final Published Version (URL): http://dx.doi.org/10.1089/apc.2013.0263
• Title of Journal or Parent Work: AIDS Patient Care and STDs
• ISSN: 1087-2914
• Volume: 27
• Issue: 12
• Start Page: 657
• End Page: 668
• Grant/Funding Information: Grant support from Emory University Center for AIDS Research (CFAR) (P30 AI050409) and the Emory School of Medicine Division of Infectious Diseases, NIH (P30 AI60354 to Harvard University CFAR and K24 RR16482 to D.R.K.), Harvard University Program on AIDS, CDC Cooperative Agreement (U62/CCU123541-01), Elizabeth Glaser Pediatric AIDS Foundation as part of Project HEART, Research and Health Sciences IT Division (UL1RR025008), and the Gilead Foundation.
• Keywords: Infectious Diseases; Public, Environmental & Occupational Health; STRUCTURAL BARRIERS; NAIVE PATIENTS; PUBLIC, ENVIRONMENTAL & OCCUPATIONAL HEALTH, SSCI; OUTCOMES; ADVERSE EVENTS; REGIMEN; INFECTED INDIVIDUALS; Life Sciences & Biomedicine; Science & Technology; PREDICTORS; COMBINATION ANTIRETROVIRAL THERAPY; INFECTIOUS DISEASES; ART ADHERENCE; HIV DRUG-RESISTANCE
• Research Categories: Health Sciences, General; Health Sciences, Public Health

Abstract

We sought to develop individual-level Early Warning Indicators (EWI) of virologic failure (VF) for clinicians to use during routine care complementing WHO population-level EWI. A case-control study was conducted at a Durban clinic. Patients after≥5 months of first-line antiretroviral therapy (ART) were defined as cases if they had VF [HIV-1 viral load (VL)>1000 copies/mL] and controls (2:1) if they had VL≤1000 copies/mL. Pharmacy refills and pill counts were used as adherence measures. Participants responded to a questionnaire including validated psychosocial and symptom scales. Data were also collected from the medical record. Multivariable logistic regression models of VF included factors associated with VF (p<0.05) in univariable analyses. We enrolled 158 cases and 300 controls. In the final multivariable model, male gender, not having an active religious faith, practicing unsafe sex, having a family member with HIV, not being pleased with the clinic experience, symptoms of depression, fatigue, or rash, low CD4 counts, family recommending HIV care, and using a TV/radio as ART reminders (compared to mobile phones) were associated with VF independent of adherence measures. In this setting, we identified several key individual-level EWI associated with VF including novel psychosocial factors independent of adherence measures. © 2013 Mary Ann Liebert, Inc.