Treatment interruption and variation in tablet taking behaviour result in viral failure: a case-control study from Cape Town, South Africa.

<h4>Background</h4>Understanding of the impact of non-structured treatment interruption (TI) and variation in tablet-taking on failure of first-line antiretroviral therapy (ART) is limited in a resource-poor setting.<h4>Methods</h4>A retrospective matched case-control analysi...

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Autores principales:	Lisa-Noelle Ncaca, Katharina Kranzer, Catherine Orrell
Formato:	article
Lenguaje:	EN
Publicado:	Public Library of Science (PLoS) 2011
Materias:	Medicine R Science Q
Acceso en línea:	https://doaj.org/article/bbe75fae51fe4333b1de4689c4f3eab1
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spelling	oai:doaj.org-article:bbe75fae51fe4333b1de4689c4f3eab12021-11-18T06:48:28ZTreatment interruption and variation in tablet taking behaviour result in viral failure: a case-control study from Cape Town, South Africa.1932-620310.1371/journal.pone.0023088https://doaj.org/article/bbe75fae51fe4333b1de4689c4f3eab12011-01-01T00:00:00Zhttps://www.ncbi.nlm.nih.gov/pmc/articles/pmid/21858001/?tool=EBIhttps://doaj.org/toc/1932-6203<h4>Background</h4>Understanding of the impact of non-structured treatment interruption (TI) and variation in tablet-taking on failure of first-line antiretroviral therapy (ART) is limited in a resource-poor setting.<h4>Methods</h4>A retrospective matched case-control analysis. Individuals failing ART were matched by time on ART with 4 controls. Viral load (VL) and CD4 count were completed 4-monthly. Adherence percentages, from tablet returns, were calculated 4-monthly (interval) and from ART start (cumulative). Variation between intervals and TI (>27 days off ART) were recorded. Conditional multivariate logistic regression analysis was performed to estimate the effect of cumulative adherence <90%, at least one episode of adherence variation >10% and TI on virological failure. Age, gender, baseline log VL and CD4 were included as possible confounders in the multivariate model.<h4>Results</h4>244 patients (44 cases, 200 controls) were included. Median age was 32 years (IQR28-37), baseline CD4 108 cells/mm3 (IQR56-151), VL 4.82 log (IQR4.48-5.23). 94% (96% controls, 86% failures) had cumulative adherence >90%. The odds of failure increased 3 times (aOR 3.01, 95%CI 0.81-11.21) in individuals with cumulative adherence <90%, 2.2 times (aOR 2.20, 95%CI 1.04-4.64) in individuals with at least one episode of fluctuating adherence of >10% and 4.01 times (aOR 4.01, 95%CI 1.45-11.10) in individuals with TIs. For individuals with TI and cumulative adherence >95%, the odds of failing were 5.65 (CI 1.40-22.85).<h4>Conclusion</h4>It is well known that poor cumulative adherence increases risk of virological failure, but less well understood that TI and variations in tablet-taking also play a key role, despite otherwise excellent adherence.Lisa-Noelle NcacaKatharina KranzerCatherine OrrellPublic Library of Science (PLoS)articleMedicineRScienceQENPLoS ONE, Vol 6, Iss 8, p e23088 (2011)
institution	DOAJ
collection	DOAJ
language	EN
topic	Medicine R Science Q
spellingShingle	Medicine R Science Q Lisa-Noelle Ncaca Katharina Kranzer Catherine Orrell Treatment interruption and variation in tablet taking behaviour result in viral failure: a case-control study from Cape Town, South Africa.
description	<h4>Background</h4>Understanding of the impact of non-structured treatment interruption (TI) and variation in tablet-taking on failure of first-line antiretroviral therapy (ART) is limited in a resource-poor setting.<h4>Methods</h4>A retrospective matched case-control analysis. Individuals failing ART were matched by time on ART with 4 controls. Viral load (VL) and CD4 count were completed 4-monthly. Adherence percentages, from tablet returns, were calculated 4-monthly (interval) and from ART start (cumulative). Variation between intervals and TI (>27 days off ART) were recorded. Conditional multivariate logistic regression analysis was performed to estimate the effect of cumulative adherence <90%, at least one episode of adherence variation >10% and TI on virological failure. Age, gender, baseline log VL and CD4 were included as possible confounders in the multivariate model.<h4>Results</h4>244 patients (44 cases, 200 controls) were included. Median age was 32 years (IQR28-37), baseline CD4 108 cells/mm3 (IQR56-151), VL 4.82 log (IQR4.48-5.23). 94% (96% controls, 86% failures) had cumulative adherence >90%. The odds of failure increased 3 times (aOR 3.01, 95%CI 0.81-11.21) in individuals with cumulative adherence <90%, 2.2 times (aOR 2.20, 95%CI 1.04-4.64) in individuals with at least one episode of fluctuating adherence of >10% and 4.01 times (aOR 4.01, 95%CI 1.45-11.10) in individuals with TIs. For individuals with TI and cumulative adherence >95%, the odds of failing were 5.65 (CI 1.40-22.85).<h4>Conclusion</h4>It is well known that poor cumulative adherence increases risk of virological failure, but less well understood that TI and variations in tablet-taking also play a key role, despite otherwise excellent adherence.
format	article
author	Lisa-Noelle Ncaca Katharina Kranzer Catherine Orrell
author_facet	Lisa-Noelle Ncaca Katharina Kranzer Catherine Orrell
author_sort	Lisa-Noelle Ncaca
title	Treatment interruption and variation in tablet taking behaviour result in viral failure: a case-control study from Cape Town, South Africa.
title_short	Treatment interruption and variation in tablet taking behaviour result in viral failure: a case-control study from Cape Town, South Africa.
title_full	Treatment interruption and variation in tablet taking behaviour result in viral failure: a case-control study from Cape Town, South Africa.
title_fullStr	Treatment interruption and variation in tablet taking behaviour result in viral failure: a case-control study from Cape Town, South Africa.
title_full_unstemmed	Treatment interruption and variation in tablet taking behaviour result in viral failure: a case-control study from Cape Town, South Africa.
title_sort	treatment interruption and variation in tablet taking behaviour result in viral failure: a case-control study from cape town, south africa.
publisher	Public Library of Science (PLoS)
publishDate	2011
url	https://doaj.org/article/bbe75fae51fe4333b1de4689c4f3eab1
work_keys_str_mv	AT lisanoellencaca treatmentinterruptionandvariationintablettakingbehaviourresultinviralfailureacasecontrolstudyfromcapetownsouthafrica AT katharinakranzer treatmentinterruptionandvariationintablettakingbehaviourresultinviralfailureacasecontrolstudyfromcapetownsouthafrica AT catherineorrell treatmentinterruptionandvariationintablettakingbehaviourresultinviralfailureacasecontrolstudyfromcapetownsouthafrica
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Treatment interruption and variation in tablet taking behaviour result in viral failure: a case-control study from Cape Town, South Africa.

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