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Adherence Measured Using Electronic Dose Monitoring is Associated with Emergent Antiretroviral Resistance and Poor Outcomes in People with Human Immunodeficiency Virus/AIDS and Multidrug-Resistant Tuberculosis.
- Source :
- Clinical Infectious Diseases; Nov2022, Vol. 75 Issue 9, p1489-1496, 8p
- Publication Year :
- 2022
-
Abstract
- Background Medication adherence is known to challenge treatment of human immunodeficiency virus (HIV)/AIDS and multidrug-resistant tuberculosis (MDR-TB). We hypothesized that adherence using electronic dose monitoring (EDM) would identify an antiretroviral therapy (ART) adherence threshold for emergent ART resistance and predict treatment outcomes in patients with MDR-TB and HIV on ART and bedaquiline-containing TB regimens. Methods A prospective cohort of adults with MDR-TB and HIV on ART and initiating MDR-TB treatment with bedaquiline were enrolled at a public hospital in KwaZulu-Natal, South Africa (PRAXIS Study). Participants received separate EDM devices that measure adherence to bedaquiline and ART (nevirapine or lopinavir/ritonavir). Adherence was calculated cumulatively over 6 months. Participants were followed through completion of MDR-TB treatment. HIV genome sequencing was performed at baseline and 2 and 6 months on samples with HIV RNA ≥1000 copies/mL. Results From November 2016 through February 2018, 198 persons with MDR-TB and HIV were enrolled and followed (median, 17.2 months; interquartile range, 12.2–19.6). Eleven percent had baseline ART resistance mutations, and 7.5% developed emergent ART resistance at 6 months. ART adherence was independently associated with ART resistance and mortality. Modeling identified a significant (P <.001), linear association between ART adherence and emergent resistance, suggesting a strong association without a specific threshold. Conclusions Our findings highlight the need for ART resistance testing, especially in patients with MDR-TB and HIV, which is currently not the standard of care in resource-limited settings. Despite short follow-up duration, reduced ART adherence was significantly associated with emergent resistance and increased mortality. Clinical Trials Registration NCT03162107. [ABSTRACT FROM AUTHOR]
- Subjects :
- CLINICAL drug trials
HIV infections
DRUG delivery systems
NEVIRAPINE
STATISTICS
SEQUENCE analysis
GENETIC mutation
SCIENTIFIC observation
CONFIDENCE intervals
SUBSTANCE abuse
VIRAL load
BLOOD plasma
MULTIPLE regression analysis
AGE distribution
ANTIRETROVIRAL agents
RNA
ACQUISITION of data
TREATMENT effectiveness
RISK assessment
SEX distribution
ANTITUBERCULAR agents
DRUG monitoring
MULTIDRUG resistance
PUBLIC hospitals
GENOMES
DESCRIPTIVE statistics
QUESTIONNAIRES
MEDICAL records
PATIENT compliance
STATISTICAL models
POLYMERASE chain reaction
ANALYTICAL chemistry techniques
DATA analysis software
LOGISTIC regression analysis
ODDS ratio
BODY mass index
AIDS-related opportunistic infections
LONGITUDINAL method
LOPINAVIR-ritonavir
PROPORTIONAL hazards models
Subjects
Details
- Language :
- English
- ISSN :
- 10584838
- Volume :
- 75
- Issue :
- 9
- Database :
- Complementary Index
- Journal :
- Clinical Infectious Diseases
- Publication Type :
- Academic Journal
- Accession number :
- 159959237
- Full Text :
- https://doi.org/10.1093/cid/ciac232