New tool helps identify nonadherent HIV patients

Researchers have developed a simple tool that predicts virologic response and development of drug resistance in patients receiving HIV treatment, based on how regularly they attend their scheduled health appointments.

"The tool could help to identify patients who are not adhering to treatment in settings where viral load monitoring is not available," say Mathieu Bastard (Epicentre, Paris, France) and colleagues.

Viral load monitoring and genotyping are frequently used to identify nonadherent patients but access to these laboratory diagnostics is often poor in resource-limited settings. "Simple alternative tools for rapidly detecting patients who do not regularly take their antiretroviral drugs as prescribed are therefore urgently needed," explain the researchers.

In a pooled analysis of seven cross-sectional studies with data available for 3833 patients, an adherence indicator was calculated based on patients' appointment-keeping, with delay in attending defined as going to the appointment 1 day or more after the scheduled date.

Of 3580 adults included in the studies, 58% had good adherence (delayed in attending appointments less than 5% of the time), 36% had moderate adherence (delayed 5-19% of the time), and 6% had poor adherence (delayed for ≥20% of appointments). Among pediatric patients (n=253), the corresponding proportions for the respective adherence categories were 43%, 43%, and 14%.

Multivariate analysis showed that patients categorized as having poor versus good levels of adherence, were significantly less likely to have an HIV viral load that was undetectable, and two to three times more likely to be in virologic failure (as defined by current World Health Organization criteria) and to have developed resistance mutations to antiretroviral treatment (ART).

These associations were observed among both adults and children and did not vary with the type of ART.

"This indicator represents a simple tool that could be used in HIV treatment programmes for prompt identification of non-adherent patients who need strong, targeted support and counselling to prevent virological failure and drug resistance development," suggests the team.

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