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Clinical factors associated with suboptimal adherence to antiretroviral therapy in Asia

Clinical factors associated with suboptimal adherence to antiretroviral therapy in Asia

Adherence to combination antiretroviral therapy (cART ) plays an important role on treatment outcomes. The TREAT Asia Studies to Evaluate Resistance – Monitoring Cohort Study (TASER-M) collects patients’ adherence based on a Visual Analogue Scale. The aim of this analysis was to assess the rates of, and factors associated with, suboptimal adherence in the first 24 months of initial cART in Asian patients.

Methods: Suboptimal adherence was defined as reported adherence <100%. Follow-up time started from cART initiation and censored at 24 months, lost to follow up, death, treatment switch due to any reason, or treatment cessation of more than 14 days. Follow-up time was divided into 6 monthly intervals: 0-6, 6-12,12-18 and 18-24 months. Factors associated with suboptimal adherence was analysed using generalised estimating equations. results: 1316 patients across 5 countries in Asia were included. The rates of suboptimal adherence for time intervals 0-6, 6-12, 12-18 and 18-24 months were 26%, 17%, 12% and 10%, respectively. In multivariate analyses, sites with average adherence assessment of >2 times/year were associated with decreased odds of suboptimal adherence (OR=0.7, 95%CI(0.55-0.90), p=0.006). Compared to patients with heterosexual exposure, injecting drug users were almost twice as likely to report <100% adherence (OR=1.92, 95%CI(1.23-3.00), p=0.004), while the odds in homosexual individuals was halved (OR=0.52, 95%CI(0.38-0.71), p<0.001). Patients taking NRTI+PI as their initial regimen had a 64% reduction in suboptimal adherence (OR=0.36, 95%CI(0.20-0.67), p=0.001) compared to those on NRTI+NNRTI. Increasing time interval was associated with decreasing odds (ORs=0.59, 0.40 and 0.35, respectively, all p<0.001).

Conclusions: Suboptimal adherence was higher with injecting drug users, and lower with homosexual exposure. Increased adherence assessments was associated with reduction in suboptimal adherence, possibly reflecting site resourcing for patient counselling. PI based initial regimen and longer time intervals were associated with improved adherence.

Conference: ASHM 2013
Areas of Interest / Categories: AIDS 2013, Anti RetroViral Therapy, HIV, Treatment

AIDS 2013

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HIV disease is associated with chronic inflammation and activation of the innate immune system. This state, as measured using plasma markers of inflammation, persists following suppression of HIV viremia using antiretroviral therapy, and may increase risk of non-AIDS co-morbidities. The causes of innate immune activation in the setting of virological suppression are unclear. Natural killer (NK) cells are innate immune cells that kill virus-infected and transformed cells without prior sensitization. We have shown that NK cells are activated both phenotypically (elevated expression of HLA-DR) and functionally (increased spontaneous degranulation measured by CD107a surface expression) in virologically suppressed (VS) HIV+ individuals. NK cells also lose expression of CD16, the receptor which mediates antibody-dependent cellular cytotoxicity.

Men who take more risks avoid HIV testing due to structural barriers

Regular HIV testing is recommended in men who take sexual risks. We assessed the relationship between perceived barriers to HIV testing, and frequency of testing among men who engaged in unprotected anal intercourse with casual partners (UAIC), to inform HIV testing strategies.

Delayed HIV diagnoses among gay and bisexual men in Australia

The majority of HIV diagnoses including delayed diagnoses in Australia occur among men who report homosexual contact – hereafter called gay and bisexual men (GBM). Delayed diagnosis is strongly associated with increased HIV-related mortality and morbidity. People who are unaware of their HIV-positive status may also be unwittingly transmitting HIV. We assessed trends in delayed HIV diagnoses among GBM in Australia.

Complex case report that illustrates the paucity of data for long term management of Visceral Leishmania-HIV co-infection.

HIV-associated leishmaniasis, endemic in the Mediterranean basin is a growing problem in India, Brazil and East Africa. Despite surviving for than 20 years, the clinical course of our visceral-leishmania (VL)-HIV co-infected patient illustrates several management challenges including diagnosis, speciation and drug resistance; monitoring burden of disease; access to and use of VL-treatments; end-organ toxicity and the combined immunosuppressive effects of HIV-VL.

Reinvigorating evidence for action and capacity in community HIV programs (REACH Project)

REACH was a collaborative research and practice initiative to develop evidence building frameworks, capacity, tools and resources with the Victorian HIV community partnership.

The Contribution of Partner Testing to PPTCT Efforts and Getting to Zero New Pediatric HIV Infections in Papua New Guinea

As part of the adult HIV and PPTCT (The Prevention of Parent to Child Transmission) services, Clinton Health Access Initiative, in collaboration with the Papua New Guinea Department of Health and Eastern Highlands Provincial Health Authority, implemented an HIV partner testing program in a public sector health center in Eastern Highlands Province in 2007. The program aimed to facilitate partner testing and disclosure in a safe environment, remove obstacles to care, involve partners in the promotion of infant HIV-free survival, increase early case detection and treatment among individuals at high-risk of HIV, and promote adherence antiretroviral treatment among PPTCT mothers.

Definitions of early first sexual intercourse

Early first sexual intercourse has been proposed as an important marker of later sexual and reproductive health. Discussions of what constitutes early sexual debut in this context, however, have been limited.

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