Journal Article

Virological failure on first-line antiretroviral therapy; associated factors and a pragmatic approach for switching to second line therapy evidence from a prospective cohort study in rural South-Western Uganda, 2004-2011

Masiira, Ben, Kaleebu, Pontiano, Kazooba, Patrick, Mayanja, Billy Nsubuga, Levin, Jonathan

2018

Overview

We investigated factors affecting Virological failure (VF) on first line Antiretroviral Therapy (ART) and evaluated a pragmatic approach to switching to second line ART. Between 2004 and 2011, we assessed adults taking ART. After 6 months or more on ART, participants with VL >1000 copies/ml or two successive VL > 400 copies/ml (Conventional VF) received intensified adherence counselling and continued on first-line ART for 6 more months, after which participants who still had VL > 1000 copies/ml (Pragmatic VF) were switched to second line ART. VF rates were calculated and predictors of failure were found by fitting logistic regression and Cox proportional hazards models. The 316 participants accrued 1036 person years at risk (pyar), 84 (26.6%) had conventional VF (rate 8.6 per 100 pyar) of whom 28 (33.3%) had pragmatic VF (rate 2.7 per 100 pyar). Independent predictors of conventional VF were; alcohol consumption, (adjusted Hazard Ratio; aHR = 1.71, 95% CI 1.05-2.79, P = 0.03) and ART adherence: per 10% decrease in proportion of adherent visits, (aHR = 1.83, 95% CI 1.50-2.23; P < 0.001). Using reference age group < 30 years, among conventional failures, the adjusted odds ratio (aOR) of pragmatic failure for age group 30-39 years were 0.12, 95% CI 0.03-0.57, P = 0.02 and for age group > 40 years were 0.14, 95%CI 0.03-0.71, P = 0.02. Alcohol consumers had a threefold odds of pragmatic failure than non-alcohol consumers (aOR = 3.14, 95%CI 0.95-10.34, P = 0.06). A pragmatic VF approach is essential to guide switching to second line ART. Patient tailored ART adherence counselling among young patients and alcohol users is recommended.

• Publisher: PAMJ-CEPHRI Pan African Medical Journal - Center for Public health Research and Information,The African Field Epidemiology Network,The Pan African Medical Journal
• Subject: Acquired immune deficiency syndrome / Adolescent / Adult / Aged / AIDS / Alcohol / Alcohol Drinking - epidemiology / Anti-HIV Agents - administration & dosage / Antiretroviral drugs / Bias / Cohort analysis / Cohort Studies / Consumption / conventional / Counseling / Drug resistance / Drug therapy / Failure / Female / first line art / Follow-Up Studies / HIV / HIV Infections - drug therapy / HIV Infections - virology / Human immunodeficiency virus / Humans / Laboratories / Logistic Models / Male / Medication Adherence / Middle Aged / Mortality / pragmatic / Proportional Hazards Models / Prospective Studies / Rural Population / second line art / Treatment Failure / Uganda / virological failure / Young Adult