Risk factors for virological failure and subtherapeutic antiretroviral drug concentrations in HIV-positive adults treated in rural northwestern Uganda

BMC Infect Dis. 2009 Jun 3;9:81. doi: 10.1186/1471-2334-9-81.

Abstract

Background: Little is known about immunovirological treatment outcomes and adherence in HIV/AIDS patients on antiretroviral therapy (ART) treated using a simplified management approach in rural areas of developing countries, or about the main factors influencing those outcomes in clinical practice.

Methods: Cross-sectional immunovirological, pharmacological, and adherence outcomes were evaluated in all patients alive and on fixed-dose ART combinations for 24 months, and in a random sample of those treated for 12 months. Risk factors for virological failure (>1,000 copies/ml) and subtherapeutic antiretroviral (ARV) concentrations were investigated with multiple logistic regression.

Results: At 12 and 24 months of ART, 72% (n = 701) and 70% (n = 369) of patients, respectively, were alive and in care. About 8% and 38% of patients, respectively, were diagnosed with immunological failure; and 75% and 72% of patients, respectively, had undetectable HIV RNA (<400 copies/ml). Risk factors for virological failure (>1,000 copies/ml) were poor adherence, tuberculosis diagnosed after ART initiation, subtherapeutic NNRTI concentrations, general clinical symptoms, and lower weight than at baseline. About 14% of patients had low ARV plasma concentrations. Digestive symptoms and poor adherence to ART were risk factors for low ARV plasma concentrations.

Conclusion: Efforts to improve both access to care and patient management to achieve better immunological and virological outcomes on ART are necessary to maximize the duration of first-line therapy.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Anti-HIV Agents / blood
  • Anti-HIV Agents / therapeutic use*
  • Cross-Sectional Studies
  • Developing Countries
  • Drug Resistance, Viral / genetics
  • Female
  • HIV Seropositivity / blood
  • HIV Seropositivity / drug therapy*
  • HIV Seropositivity / epidemiology
  • HIV-1 / drug effects
  • HIV-1 / genetics
  • Humans
  • Logistic Models
  • Male
  • Patient Compliance / statistics & numerical data
  • RNA, Viral / blood
  • Retrospective Studies
  • Risk Factors
  • Rural Population
  • Treatment Outcome
  • Uganda / epidemiology

Substances

  • Anti-HIV Agents
  • RNA, Viral