Impact of immune reconstitution inflammatory syndrome on antiretroviral therapy adherence

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dc.contributor.authorNachega, Jean B
dc.contributor.authorMorroni, Chelsea
dc.contributor.authorChaisson, Richard E
dc.contributor.authorGoliath, Rene
dc.contributor.authorEfron, Anne
dc.contributor.authorRam, Malathi
dc.contributor.authorMaartens, Gary
dc.date.accessioned2021-10-08T07:08:33Z
dc.date.available2021-10-08T07:08:33Z
dc.date.issued2012
dc.description.abstractObjectiveWe determined the impact of immune reconstitution inflammatory syndrome (IRIS) on antiretroviral therapy (ART) adherence in a cohort of 274 human immunodeficiency virus (HIV)-infected South African adults initiating ART.MethodsWe carried out a secondary analysis of data from a randomized controlled trial of partially supervised ART in Cape Town, South Africa. Monthly pill count adherence, viral suppression (HIV viral load < 50 c/mL), and IRIS events were documented. Poisson regression was used to identify variables associated with ART adherence below the median in the first 6 months of ART.ResultsWe enrolled 274 patients: 58% women, median age 34 years, median CD4 count 98 cells/μL, 46% World Health Organization clinical stage IV, and 40% on treatment for tuberculosis (TB). IRIS and TB-IRIS developed in 8.4% and 6.6% of patients, respectively. The median cumulative adherence at 6 months for those with an IRIS event vs no IRIS was 95.5% vs 98.2% (P = 0.04). Although not statistically significant, patients developing IRIS had a lower 6-month viral load suppression than those without IRIS (68% vs 80%, P = 0.32). ART adherence below the median of 98% was independently associated with alcohol abuse (relative risk [RR] 1.5; 95% confidence interval [CI] 1.2–1.9; P = 0.003) and IRIS events (RR 1.7; 95% CI 1.2–2.2; P = 0.001).ConclusionAlthough IRIS events were associated with slightly lower adherence rates, overall adherence to ART remained high in this study population. Concerns about IRIS should not deter clinicians from early ART initiation.
dc.identifier.apacitationNachega, J. B., Morroni, C., Chaisson, R. E., Goliath, R., Efron, A., Ram, M., & Maartens, G. (2012). Impact of immune reconstitution inflammatory syndrome on antiretroviral therapy adherence. <i>Patient Preference and Adherence</i>, 49(4), 887 - 177. http://hdl.handle.net/11427/34604en_ZA
dc.identifier.chicagocitationNachega, Jean B, Chelsea Morroni, Richard E Chaisson, Rene Goliath, Anne Efron, Malathi Ram, and Gary Maartens "Impact of immune reconstitution inflammatory syndrome on antiretroviral therapy adherence." <i>Patient Preference and Adherence</i> 49, 4. (2012): 887 - 177. http://hdl.handle.net/11427/34604en_ZA
dc.identifier.citationNachega, J.B., Morroni, C., Chaisson, R.E., Goliath, R., Efron, A., Ram, M. & Maartens, G. 2012. Impact of immune reconstitution inflammatory syndrome on antiretroviral therapy adherence. <i>Patient Preference and Adherence.</i> 49(4):887 - 177. http://hdl.handle.net/11427/34604en_ZA
dc.identifier.issn1177-889X
dc.identifier.ris TY - Journal Article AU - Nachega, Jean B AU - Morroni, Chelsea AU - Chaisson, Richard E AU - Goliath, Rene AU - Efron, Anne AU - Ram, Malathi AU - Maartens, Gary AB - ObjectiveWe determined the impact of immune reconstitution inflammatory syndrome (IRIS) on antiretroviral therapy (ART) adherence in a cohort of 274 human immunodeficiency virus (HIV)-infected South African adults initiating ART.MethodsWe carried out a secondary analysis of data from a randomized controlled trial of partially supervised ART in Cape Town, South Africa. Monthly pill count adherence, viral suppression (HIV viral load < 50 c/mL), and IRIS events were documented. Poisson regression was used to identify variables associated with ART adherence below the median in the first 6 months of ART.ResultsWe enrolled 274 patients: 58% women, median age 34 years, median CD4 count 98 cells/μL, 46% World Health Organization clinical stage IV, and 40% on treatment for tuberculosis (TB). IRIS and TB-IRIS developed in 8.4% and 6.6% of patients, respectively. The median cumulative adherence at 6 months for those with an IRIS event vs no IRIS was 95.5% vs 98.2% (P = 0.04). Although not statistically significant, patients developing IRIS had a lower 6-month viral load suppression than those without IRIS (68% vs 80%, P = 0.32). ART adherence below the median of 98% was independently associated with alcohol abuse (relative risk [RR] 1.5; 95% confidence interval [CI] 1.2–1.9; P = 0.003) and IRIS events (RR 1.7; 95% CI 1.2–2.2; P = 0.001).ConclusionAlthough IRIS events were associated with slightly lower adherence rates, overall adherence to ART remained high in this study population. Concerns about IRIS should not deter clinicians from early ART initiation. DA - 2012 DB - OpenUCT DP - University of Cape Town IS - 4 J1 - Patient Preference and Adherence LK - https://open.uct.ac.za PY - 2012 SM - 1177-889X T1 - Impact of immune reconstitution inflammatory syndrome on antiretroviral therapy adherence TI - Impact of immune reconstitution inflammatory syndrome on antiretroviral therapy adherence UR - http://hdl.handle.net/11427/34604 ER - en_ZA
dc.identifier.urihttp://hdl.handle.net/11427/34604
dc.identifier.vancouvercitationNachega JB, Morroni C, Chaisson RE, Goliath R, Efron A, Ram M, et al. Impact of immune reconstitution inflammatory syndrome on antiretroviral therapy adherence. Patient Preference and Adherence. 2012;49(4):887 - 177. http://hdl.handle.net/11427/34604.en_ZA
dc.language.isoeng
dc.publisher.departmentDepartment of Medicine
dc.publisher.facultyFaculty of Health Sciences
dc.sourcePatient Preference and Adherence
dc.source.journalissue4
dc.source.journalvolume49
dc.source.pagination887 - 177
dc.source.urihttps://dx.doi.org/10.2147/PPA.S38897
dc.subject.otherART
dc.subject.otherIRIS
dc.subject.otherDOAJ:Therapeutics
dc.subject.otherR5-920
dc.subject.otheradherence
dc.subject.otherPatient Preference and Adherence
dc.subject.otherMedicine
dc.subject.otherDOAJ:Medicine (General)
dc.subject.otherDOAJ:Health Sciences
dc.subject.otherTB
dc.subject.otherR
dc.subject.otherRM1-950
dc.subject.otherTherapeutics. Pharmacology
dc.subject.otherMedicine (General)
dc.subject.otherHIV/AIDS
dc.subject.otherOriginal Research
dc.titleImpact of immune reconstitution inflammatory syndrome on antiretroviral therapy adherence
dc.typeJournal Article
uct.type.publicationResearch
uct.type.resourceJournal Article
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