Suboptimal Adherence and Associated Factors Contributing to Virological Failure on First Line ART at a Private Tertiary Care Centre in South India: Implications for Individualized Adherence Interventions in Resource-limited Settings
Laxman G Jessani, Ram Gopalakrishnan, Suresh D, S Nambi and V Ramasubramanian
Journal Title:Acta Scientific Microbiology
Background:Suboptimal adherence to ART can lead to HIV drug resistance. We studied the incidence and factors leading to first-line ART failure and the socio-demographic, behavioral and clinical risk factors associated with non-adherence to ART.
Methods:We carried out a retrospective case-controlstudy of adult HIV-1 positive patients who were on first line ART over a period of 10 years. Adherence and history of treatment interruptions for > 48h were noted by self-report. Kaplan Meier survival curves (Figure 2) were used to estimate the median time to first line ART treatment failure. Logistic regression and Cox proportional hazard model were used to predict ART treatment failure.
Results: Among 290 participants, 80 (27.58%) cumulatively had first-line failure. Patients who had virological failure on first line ART were taken as cases (n = 80) and those who were virologically suppressed were taken as controls (n = 210). Mean time to failure was41.16 ± 11.11 months.45% failed after more than 5 yrs on treatment: only4% failed within the first 6 months.Lower baseline CD4 count, WHO stage IV, CDC stage 3 and poor adherence were significantly associated with first line failure.70% of patients re-ported suboptimal adherence while 68% reported treatment interruptions.Poor adherence was significantly associated with viro-logical failure (P < 0.001) with OR = 4.22 (2.68 - 6.62) and CD4 count < 200 andART duration > 3 years was associated with poorer adherence.
Conclusion: Our study demonstrates a strong association between suboptimal adherence, virological failure and drug resistance among patients on first-line ART