Early mortality and AIDS progression despite high initial antiretroviral therapy adherence and virologic suppression in Botswana
Adverse outcomes occurring early after antiretroviral therapy (ART) initiation are common in sub-Saharan Africa, despite reports of high levels of ART adherence in this setting. We sought to determine the relationship between very early ART adherence and early adverse outcomes in HIV-infected adults...
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| Veröffentlicht in: | PloS one 2011-06, Vol.6 (6), p.e20010-e20010 |
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| creator | Steele, Katherine T Steenhoff, Andrew P Newcomb, Craig W Rantleru, Tumelo Nthobatsang, Rudo Lesetedi, Gloria Bellamy, Scarlett L Nachega, Jean B Gross, Robert Bisson, Gregory P |
| description | Adverse outcomes occurring early after antiretroviral therapy (ART) initiation are common in sub-Saharan Africa, despite reports of high levels of ART adherence in this setting. We sought to determine the relationship between very early ART adherence and early adverse outcomes in HIV-infected adults in Botswana.
This prospective cohort study of 402 ART-naïve, HIV-infected adults initiating ART at a public HIV clinic in Gaborone, Botswana evaluated the relationship between suboptimal early ART adherence and HIV treatment outcomes in the initial months after ART initiation. Early adherence during the interval between initial ART dispensation and first ART refill was calculated using pill counts. In the primary analysis patients not returning to refill and those with adherence |
| doi_str_mv | 10.1371/journal.pone.0020010 |
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This prospective cohort study of 402 ART-naïve, HIV-infected adults initiating ART at a public HIV clinic in Gaborone, Botswana evaluated the relationship between suboptimal early ART adherence and HIV treatment outcomes in the initial months after ART initiation. Early adherence during the interval between initial ART dispensation and first ART refill was calculated using pill counts. In the primary analysis patients not returning to refill and those with adherence <0.95 were considered to have suboptimal early adherence. The primary outcome was death or loss to follow-up during the first 6 months of ART; a secondary composite outcome included the primary outcome plus incident opportunistic illness (OIs) and virologic failure. We also calculated the percent of early adverse outcomes theoretically attributable to suboptimal early adherence using the population attributable risk percent (PAR%).
Suboptimal early adherence was independently associated with loss to follow-up and death (adjusted OR 2.3, 95% CI 1.1-4.8) and with the secondary composite outcome including incident OIs and virologic failure (adjusted OR 2.6, 95% CI 1.4-4.7). However, of those with early adverse outcomes, less than one-third had suboptimal adherence and approximately two-thirds achieved virologic suppression. The PAR% relating suboptimal early adherence and primary and secondary outcomes were 14.7% and 17.7%, respectively.
Suboptimal early adherence was associated with poor outcomes, but most early adverse outcomes occurred in patients with optimal early adherence. Clinical care and research efforts should focus on understanding early adverse outcomes that occur despite optimal adherence.</description><identifier>ISSN: 1932-6203</identifier><identifier>EISSN: 1932-6203</identifier><identifier>DOI: 10.1371/journal.pone.0020010</identifier><identifier>PMID: 21698283</identifier><language>eng</language><publisher>United States: Public Library of Science</publisher><subject>Acquired immune deficiency syndrome ; Acquired Immunodeficiency Syndrome - drug therapy ; Acquired Immunodeficiency Syndrome - mortality ; Acquired Immunodeficiency Syndrome - physiopathology ; Acquired Immunodeficiency Syndrome - virology ; Adhesion ; Adult ; Adults ; Aged ; AIDS ; AIDS treatment ; Analysis ; Anti-HIV Agents - therapeutic use ; Antiretroviral agents ; Antiretroviral drugs ; Antiretroviral therapy ; Biological products industry ; Biology ; Botswana ; Disease Progression ; Female ; Highly active antiretroviral therapy ; HIV ; Human immunodeficiency virus ; Humans ; Male ; Mathematical analysis ; Medicine ; Middle Aged ; Mortality ; Patient Compliance ; Patients ; Prospective Studies ; Studies ; Therapy ; Viral Load ; Womens health</subject><ispartof>PloS one, 2011-06, Vol.6 (6), p.e20010-e20010</ispartof><rights>COPYRIGHT 2011 Public Library of Science</rights><rights>2011 Steele et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License: https://creativecommons.org/licenses/by/4.0/ (the “License”), which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. Notwithstanding the ProQuest Terms and Conditions, you may use this content in accordance with the terms of the License.</rights><rights>Steele et al. 2011</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c691t-73369fa7838dc53dd8da0b68440763f27f86e06f8adeac70de194451361624d33</citedby><cites>FETCH-LOGICAL-c691t-73369fa7838dc53dd8da0b68440763f27f86e06f8adeac70de194451361624d33</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC3115945/pdf/$$EPDF$$P50$$Gpubmedcentral$$Hfree_for_read</linktopdf><linktohtml>$$Uhttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC3115945/$$EHTML$$P50$$Gpubmedcentral$$Hfree_for_read</linktohtml><link.rule.ids>230,314,725,778,782,862,883,2098,2917,23849,27907,27908,53774,53776,79351,79352</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/21698283$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><contributor>Pant Pai, Nitika</contributor><creatorcontrib>Steele, Katherine T</creatorcontrib><creatorcontrib>Steenhoff, Andrew P</creatorcontrib><creatorcontrib>Newcomb, Craig W</creatorcontrib><creatorcontrib>Rantleru, Tumelo</creatorcontrib><creatorcontrib>Nthobatsang, Rudo</creatorcontrib><creatorcontrib>Lesetedi, Gloria</creatorcontrib><creatorcontrib>Bellamy, Scarlett L</creatorcontrib><creatorcontrib>Nachega, Jean B</creatorcontrib><creatorcontrib>Gross, Robert</creatorcontrib><creatorcontrib>Bisson, Gregory P</creatorcontrib><title>Early mortality and AIDS progression despite high initial antiretroviral therapy adherence and virologic suppression in Botswana</title><title>PloS one</title><addtitle>PLoS One</addtitle><description>Adverse outcomes occurring early after antiretroviral therapy (ART) initiation are common in sub-Saharan Africa, despite reports of high levels of ART adherence in this setting. We sought to determine the relationship between very early ART adherence and early adverse outcomes in HIV-infected adults in Botswana.
This prospective cohort study of 402 ART-naïve, HIV-infected adults initiating ART at a public HIV clinic in Gaborone, Botswana evaluated the relationship between suboptimal early ART adherence and HIV treatment outcomes in the initial months after ART initiation. Early adherence during the interval between initial ART dispensation and first ART refill was calculated using pill counts. In the primary analysis patients not returning to refill and those with adherence <0.95 were considered to have suboptimal early adherence. The primary outcome was death or loss to follow-up during the first 6 months of ART; a secondary composite outcome included the primary outcome plus incident opportunistic illness (OIs) and virologic failure. We also calculated the percent of early adverse outcomes theoretically attributable to suboptimal early adherence using the population attributable risk percent (PAR%).
Suboptimal early adherence was independently associated with loss to follow-up and death (adjusted OR 2.3, 95% CI 1.1-4.8) and with the secondary composite outcome including incident OIs and virologic failure (adjusted OR 2.6, 95% CI 1.4-4.7). However, of those with early adverse outcomes, less than one-third had suboptimal adherence and approximately two-thirds achieved virologic suppression. The PAR% relating suboptimal early adherence and primary and secondary outcomes were 14.7% and 17.7%, respectively.
Suboptimal early adherence was associated with poor outcomes, but most early adverse outcomes occurred in patients with optimal early adherence. Clinical care and research efforts should focus on understanding early adverse outcomes that occur despite optimal adherence.</description><subject>Acquired immune deficiency syndrome</subject><subject>Acquired Immunodeficiency Syndrome - drug therapy</subject><subject>Acquired Immunodeficiency Syndrome - mortality</subject><subject>Acquired Immunodeficiency Syndrome - physiopathology</subject><subject>Acquired Immunodeficiency Syndrome - virology</subject><subject>Adhesion</subject><subject>Adult</subject><subject>Adults</subject><subject>Aged</subject><subject>AIDS</subject><subject>AIDS treatment</subject><subject>Analysis</subject><subject>Anti-HIV Agents - therapeutic use</subject><subject>Antiretroviral agents</subject><subject>Antiretroviral drugs</subject><subject>Antiretroviral therapy</subject><subject>Biological products industry</subject><subject>Biology</subject><subject>Botswana</subject><subject>Disease Progression</subject><subject>Female</subject><subject>Highly active antiretroviral therapy</subject><subject>HIV</subject><subject>Human immunodeficiency virus</subject><subject>Humans</subject><subject>Male</subject><subject>Mathematical analysis</subject><subject>Medicine</subject><subject>Middle Aged</subject><subject>Mortality</subject><subject>Patient Compliance</subject><subject>Patients</subject><subject>Prospective Studies</subject><subject>Studies</subject><subject>Therapy</subject><subject>Viral Load</subject><subject>Womens 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mortality and AIDS progression despite high initial antiretroviral therapy adherence and virologic suppression in Botswana</title><author>Steele, Katherine T ; Steenhoff, Andrew P ; Newcomb, Craig W ; Rantleru, Tumelo ; Nthobatsang, Rudo ; Lesetedi, Gloria ; Bellamy, Scarlett L ; Nachega, Jean B ; Gross, Robert ; Bisson, Gregory P</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c691t-73369fa7838dc53dd8da0b68440763f27f86e06f8adeac70de194451361624d33</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2011</creationdate><topic>Acquired immune deficiency syndrome</topic><topic>Acquired Immunodeficiency Syndrome - drug therapy</topic><topic>Acquired Immunodeficiency Syndrome - mortality</topic><topic>Acquired Immunodeficiency Syndrome - physiopathology</topic><topic>Acquired Immunodeficiency Syndrome - 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One</addtitle><date>2011-06-15</date><risdate>2011</risdate><volume>6</volume><issue>6</issue><spage>e20010</spage><epage>e20010</epage><pages>e20010-e20010</pages><issn>1932-6203</issn><eissn>1932-6203</eissn><abstract>Adverse outcomes occurring early after antiretroviral therapy (ART) initiation are common in sub-Saharan Africa, despite reports of high levels of ART adherence in this setting. We sought to determine the relationship between very early ART adherence and early adverse outcomes in HIV-infected adults in Botswana.
This prospective cohort study of 402 ART-naïve, HIV-infected adults initiating ART at a public HIV clinic in Gaborone, Botswana evaluated the relationship between suboptimal early ART adherence and HIV treatment outcomes in the initial months after ART initiation. Early adherence during the interval between initial ART dispensation and first ART refill was calculated using pill counts. In the primary analysis patients not returning to refill and those with adherence <0.95 were considered to have suboptimal early adherence. The primary outcome was death or loss to follow-up during the first 6 months of ART; a secondary composite outcome included the primary outcome plus incident opportunistic illness (OIs) and virologic failure. We also calculated the percent of early adverse outcomes theoretically attributable to suboptimal early adherence using the population attributable risk percent (PAR%).
Suboptimal early adherence was independently associated with loss to follow-up and death (adjusted OR 2.3, 95% CI 1.1-4.8) and with the secondary composite outcome including incident OIs and virologic failure (adjusted OR 2.6, 95% CI 1.4-4.7). However, of those with early adverse outcomes, less than one-third had suboptimal adherence and approximately two-thirds achieved virologic suppression. The PAR% relating suboptimal early adherence and primary and secondary outcomes were 14.7% and 17.7%, respectively.
Suboptimal early adherence was associated with poor outcomes, but most early adverse outcomes occurred in patients with optimal early adherence. Clinical care and research efforts should focus on understanding early adverse outcomes that occur despite optimal adherence.</abstract><cop>United States</cop><pub>Public Library of Science</pub><pmid>21698283</pmid><doi>10.1371/journal.pone.0020010</doi><oa>free_for_read</oa></addata></record> |
| fulltext | fulltext |
| identifier | ISSN: 1932-6203 |
| ispartof | PloS one, 2011-06, Vol.6 (6), p.e20010-e20010 |
| issn | 1932-6203 1932-6203 |
| language | eng |
| recordid | cdi_plos_journals_1304771233 |
| source | MEDLINE; DOAJ Directory of Open Access Journals; Elektronische Zeitschriftenbibliothek - Frei zugängliche E-Journals; Public Library of Science (PLoS); PubMed Central; Free Full-Text Journals in Chemistry |
| subjects | Acquired immune deficiency syndrome Acquired Immunodeficiency Syndrome - drug therapy Acquired Immunodeficiency Syndrome - mortality Acquired Immunodeficiency Syndrome - physiopathology Acquired Immunodeficiency Syndrome - virology Adhesion Adult Adults Aged AIDS AIDS treatment Analysis Anti-HIV Agents - therapeutic use Antiretroviral agents Antiretroviral drugs Antiretroviral therapy Biological products industry Biology Botswana Disease Progression Female Highly active antiretroviral therapy HIV Human immunodeficiency virus Humans Male Mathematical analysis Medicine Middle Aged Mortality Patient Compliance Patients Prospective Studies Studies Therapy Viral Load Womens health |
| title | Early mortality and AIDS progression despite high initial antiretroviral therapy adherence and virologic suppression in Botswana |
| url | https://sfx.bib-bvb.de/sfx_tum?ctx_ver=Z39.88-2004&ctx_enc=info:ofi/enc:UTF-8&ctx_tim=2025-01-16T18%3A47%3A46IST&url_ver=Z39.88-2004&url_ctx_fmt=infofi/fmt:kev:mtx:ctx&rfr_id=info:sid/primo.exlibrisgroup.com:primo3-Article-gale_plos_&rft_val_fmt=info:ofi/fmt:kev:mtx:journal&rft.genre=article&rft.atitle=Early%20mortality%20and%20AIDS%20progression%20despite%20high%20initial%20antiretroviral%20therapy%20adherence%20and%20virologic%20suppression%20in%20Botswana&rft.jtitle=PloS%20one&rft.au=Steele,%20Katherine%20T&rft.date=2011-06-15&rft.volume=6&rft.issue=6&rft.spage=e20010&rft.epage=e20010&rft.pages=e20010-e20010&rft.issn=1932-6203&rft.eissn=1932-6203&rft_id=info:doi/10.1371/journal.pone.0020010&rft_dat=%3Cgale_plos_%3EA476888180%3C/gale_plos_%3E%3Curl%3E%3C/url%3E&disable_directlink=true&sfx.directlink=off&sfx.report_link=0&rft_id=info:oai/&rft_pqid=1304771233&rft_id=info:pmid/21698283&rft_galeid=A476888180&rft_doaj_id=oai_doaj_org_article_312e17cef2cb473a9a7c9b7c21300360&rfr_iscdi=true |