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Adherence to first-line ART predictive of second-line ART adherence
Patients with HIV who fail to comply with first-line ART are less likely to adhere to second-line ART, according to recent findings published in Open Forum Infectious Diseases.
In a cross-sectional study, researchers evaluated 436 adolescent and adult patients with HIV being treated at five centers in Tanzania between January 2004 and August 2013. The patients were on a first-line ART regimen of fixed-dose combination stavudine, lamivudine and nevirapine. Each patient was seen for monthly visits, and switches to second-line therapy were based on clinical and immunological criteria established by WHO guidelines.
Second-line agents used included tenofovir (Viread, Gilead), abacavir and lopinavir/ritonavir (Kaletra, AbbVie). Atazanavir (Reyataz, Bristol-Myers Squibb) boosted with ritonavir (Norvir, AbbVie) was substituted for lopinavir/ritonavir when necessary. The participants completed standardized questionnaires pertaining to demographic characteristics and their compliance before and after the switch to second-line ART. The researchers also analyzed the following variables: age, gender, duration of first-line ART, treatment sites, initial CD4 cell count, CD4 cell count at the time of switch, and weight of the patient.
The researchers found that 134 (30.7%) of the study participants self-reported suboptimal compliance to second-line ART. Additionally, 117 (36.3%) of the 322 participants who had suboptimal adherence to first-line ART also had suboptimal adherence to second-line ART. Conversely, 17 (14.9%) of the 114 patients who had optimal adherence to first-line ART had suboptimal adherence to second-line ART. The researchers identified an association between suboptimal adherence to first-line ART and suboptimal adherence to second-line ART (adjusted prevalence ratio, 2.4; 95% CI, 1.5-3.9). This association remained after adjustment for age, gender, treatment site, duration on first-line ART, weight, initial CD4 cell count and CD4 cell count at the time of switch.
“Adherence to first-line ART is an important predictor of adherence to second-line ART,” the researchers wrote. “Targeted interventions should be evaluated in patients with suboptimal adherence prior to switching into second-line therapy to improve their outcomes.”
Disclosure: The researchers report no relevant financial disclosures.