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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dc.contributor.authorNcaca, Lisa-Noelleen_ZA
dc.contributor.authorKranzer, Katharinaen_ZA
dc.contributor.authorOrrell, Catherineen_ZA
dc.date.accessioned2015-11-09T13:16:46Z
dc.date.available2015-11-09T13:16:46Z
dc.date.issued2011en_ZA
dc.description.abstractBACKGROUND: 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. METHODS: 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. RESULTS: 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). CONCLUSION: 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.en_ZA
dc.identifier.apacitationNcaca, L., Kranzer, K., & Orrell, C. (2011). Treatment Interruption and Variation in Tablet Taking Behaviour Result in Viral Failure: A Case-Control Study from Cape Town, South Africa. <i>PLoS One</i>, http://hdl.handle.net/11427/14781en_ZA
dc.identifier.chicagocitationNcaca, Lisa-Noelle, Katharina Kranzer, and Catherine Orrell "Treatment Interruption and Variation in Tablet Taking Behaviour Result in Viral Failure: A Case-Control Study from Cape Town, South Africa." <i>PLoS One</i> (2011) http://hdl.handle.net/11427/14781en_ZA
dc.identifier.citationNcaca, L. N., Kranzer, K., & Orrell, C. (2011). Treatment interruption and variation in tablet taking behaviour result in viral failure: a case-control study from Cape Town, South Africa. PloS one, 6(8), e23088. doi:10.1371/journal.pone.0023088en_ZA
dc.identifier.ris TY - Journal Article AU - Ncaca, Lisa-Noelle AU - Kranzer, Katharina AU - Orrell, Catherine AB - BACKGROUND: 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. METHODS: 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. RESULTS: 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). CONCLUSION: 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. DA - 2011 DB - OpenUCT DO - 10.1371/journal.pone.0023088 DP - University of Cape Town J1 - PLoS One LK - https://open.uct.ac.za PB - University of Cape Town PY - 2011 T1 - Treatment Interruption and Variation in Tablet Taking Behaviour Result in Viral Failure: A Case-Control Study from Cape Town, South Africa TI - Treatment Interruption and Variation in Tablet Taking Behaviour Result in Viral Failure: A Case-Control Study from Cape Town, South Africa UR - http://hdl.handle.net/11427/14781 ER - en_ZA
dc.identifier.urihttp://hdl.handle.net/11427/14781
dc.identifier.urihttp://dx.doi.org/10.1371/journal.pone.0023088
dc.identifier.vancouvercitationNcaca L, Kranzer K, Orrell C. Treatment Interruption and Variation in Tablet Taking Behaviour Result in Viral Failure: A Case-Control Study from Cape Town, South Africa. PLoS One. 2011; http://hdl.handle.net/11427/14781.en_ZA
dc.language.isoengen_ZA
dc.publisherPublic Library of Scienceen_ZA
dc.publisher.departmentDesmond Tutu HIV Centreen_ZA
dc.publisher.facultyFaculty of Health Sciencesen_ZA
dc.publisher.institutionUniversity of Cape Town
dc.rightsThis is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.en_ZA
dc.rights.holder© 2011 Ncaca et alen_ZA
dc.rights.urihttp://creativecommons.org/licenses/by/4.0en_ZA
dc.sourcePLoS Oneen_ZA
dc.source.urihttp://journals.plos.org/plosoneen_ZA
dc.subject.otherAntiretroviral therapyen_ZA
dc.subject.otherViral loaden_ZA
dc.subject.otherToxicityen_ZA
dc.subject.otherProtease inhibitor therapyen_ZA
dc.subject.otherDrug therapyen_ZA
dc.subject.otherHIVen_ZA
dc.subject.otherPatientsen_ZA
dc.subject.otherRegression analysisen_ZA
dc.titleTreatment Interruption and Variation in Tablet Taking Behaviour Result in Viral Failure: A Case-Control Study from Cape Town, South Africaen_ZA
dc.typeJournal Articleen_ZA
uct.type.filetypeText
uct.type.filetypeImage
uct.type.publicationResearchen_ZA
uct.type.resourceArticleen_ZA
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