[ARCHIVED] Adherence & Retention
Not All Missed Doses Are the Same: Sustained NNRTI Treatment Interruptions Predict HIV Rebound at Low-to-Moderate Adherence Levels
Monitoring for virologic failure is challenging in resource-limited settings, particularly because of cost constraints. Adherence is an important predictor of virologic rebound and drug resistance. Many studies in sub-Saharan Africa have found that average % adherence among patients in resource-limited settings is exceptional. However, average % adherence does not capture important information with respect to patterns of adherence. An important correlate of treatment failure may be patterns of adherence, in particular treatment discontinuations. This is especially true in patients receiving non-nuke treatment regimens. When patients discontinue non-nuke regimens, nucloside analogs decay more quickly due to shorter half-lives while the non-nukes persist, creating a monotherapy often called a nevirapine or efavirenz "tail."
This study by Parenti and colleagues finds that discontinuation of non-nuke therapy is closely associated with virologic rebound and in particular, discontinuations of >15 days is associated with 50% increase in virologic rebound, and is a more sensitive predictor of virologic rebound than average % adherence. These discontinuations may occur when patients have structural and or behavioral barriers to care, resulting a delays in ARV refills.
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Not All Missed Doses Are the Same: Sustained NNRTI Treatment Interruptions Predict HIV Rebound at Low-to-Moderate Adherence Levels (download, 137.6 KB) Summary: Monitoring for virologic failure is challenging in resource-limited settings, particularly because of cost constraints. Adherence is an important predictor of virologic rebound and drug resistance. Many studies in sub-Saharan Africa have found that average % adherence among patients in resource-limited settings is exceptional. However, average % adherence does not capture important information with respect to patterns of adherence. An important correlate of treatment failure may be patterns of adherence, in particular treatment discontinuations. This is especially true in patients receiving non-nuke treatment regimens. When patients discontinue non-nuke regimens, nucloside analogs decay more quickly due to shorter half-lives while the non-nukes persist, creating a monotherapy often called a nevirapine or efavirenz "tail."
This study by Parenti and colleagues finds that discontinuation of non-nuke therapy is closely associated with virologic rebound and in particular, discontinuations of >15 days is associated with 50% increase in virologic rebound, and is a more sensitive predictor of virologic rebound than average % adherence. These discontinuations may occur when patients have structural and or behavioral barriers to care, resulting a delays in ARV refills.Source: PLoS One
Publication Date: July 30, 2008
Language: English
Keywords: Clinical Guidelines, Must-read, Publications & Research, Virologic Failure
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