Adherence to Drug-Refill Is a Useful Early Warning Indicator of Virologic and Immunologic Failure among HIV Patients on First-Line ART in South Africa 英文参考文献.docVIP

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Adherence to Drug-Refill Is a Useful Early Warning Indicator of Virologic and Immunologic Failure among HIV Patients on First-Line ART in South Africa 英文参考文献.doc

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Adherence to Drug-Refill Is a Useful Early Warning Indicator of Virologic and Immunologic Failure among HIV Patients on First-Line ART in South Africa 英文参考文献

AdherencetoDrug-RefillIsaUsefulEarlyWarning IndicatorofVirologicandImmunologicFailureamong HIVPatientsonFirst-LineARTinSouthAfrica ZiadEl-Khatib1,2*,DavidKatzenstein3,GaetanoMarrone1,FatimaLaher4,LeratoMohapi4 ,Max Petzold1,5,LynnMorris2,AnnaMiaEkstro¨m1 1Division of Global Health (IHCAR), Karolinska Institutet, Stockholm, Sweden, 2AIDS Virus Research Unit, National Institute for Communicable Diseases (NICD), Johannesburg,SouthAfrica,3DivisionofInfectiousDiseases,StanfordUniversity,PaloAlto,California,UnitedStatesofAmerica,4PerinatalHIVResearchUnit(PHRU), UniversityoftheWitwatersrand,Soweto,SouthAfrica,5NordicSchoolofPublicHealth(NHV),Gothenburg,Sweden Abstract Background:Affordablestrategiestopreventtreatmentfailureonfirst-lineregimensamongHIVpatientsareessentialfor thelong-termsuccessofantiretroviraltherapy(ART)insub-SaharanAfrica.WHOrecommendsusingroutinelycollecteddata suchasadherencetodrug-refillvisitsasearlywarningindicators.Weexaminedtheassociationbetweenadherencetodrug- refillvisitsandlong-termvirologicandimmunologicfailureamongnon-nucleosidereversetranscriptaseinhibitor(NNRTI) recipientsinSouthAfrica. Methods:In2008,456patientsonNNRTI-basedARTforamedianof44months(range12–99months;1,510person-years) wereenrolledinaretrospectivecohortstudyinSoweto.Chartswerereviewedforclinicalcharacteristicsbeforeandduring ART.MultivariablelogisticregressionandKaplan-Meiersurvivalanalysisassessedassociationswithvirologic(tworepeated VL.50copies/ml)andimmunologicfailure(asdefinedbyWHO). Results:Afteramedianof15monthsonART,19%(n=88)and19%(n=87)hadfailedvirologicallyandimmunologically respectively. A cumulative adherence of ,95% to drug-refill visits was significantly associated with both virologic and immunologicfailure(p,0.01).Inthefinalmultivariablemodel,riskfactorsforvirologicfailurewereincompleteadherence (OR2.8,95%CI1.2–6.7),andpreviousexposuretosingle-dosenevirapineoranyotherantiretrovirals(adj.OR2.1,95%CI1.2– 3.9), adjusted for age and sex. In Kaplan-Meier analysis, th