Pharmacy refill adherence compared with CD4 count changes for monitoring HIV-infected adults on antiretroviral therapy
Date
2008-05
Journal Title
Journal ISSN
Volume Title
Publisher
Public Library of Science (PLOS)
Abstract
Background
World Health Organization (WHO) guidelines for monitoring HIV-infected individuals taking
combination antiretroviral therapy (cART) in resource-limited settings recommend using CD4รพ
T cell (CD4) count changes to monitor treatment effectiveness. In practice, however, falling CD4
counts are a consequence, rather than a cause, of virologic failure. Adherence lapses precede
virologic failure and, unlike CD4 counts, data on adherence are immediately available to all
clinics dispensing cART. However, the accuracy of adherence assessments for predicting future
or detecting current virologic failure has not been determined. The goal of this study therefore
was to determine the accuracy of adherence assessments for predicting and detecting virologic
failure and to compare the accuracy of adherence-based monitoring approaches with
approaches monitoring CD4 count changes.
Methodology and Findings
We conducted an observational cohort study among 1,982 of 4,984 (40%) HIV-infected adults
initiating non-nucleoside reverse transcriptase inhibitor-based cART in the Aid for AIDS Disease
Management Program, which serves nine countries in southern Africa. Pharmacy refill
adherence was calculated as the number of months of cART claims submitted divided by the
number of complete months between cART initiation and the last refill prior to the endpoint of
interest, expressed as a percentage......Conclusions
Pharmacy refill adherence assessments were as accurate as CD4 counts for detecting current
virologic failure in this cohort of patients on cART and have the potential to predict virologic
failure before it occurs. Approaches to cART scale-up in resource-limited settings should
include an adherence-based monitoring approach.
Description
The original publication is available at http://www.plosmedicine.org
Keywords
Pharmacy refill adherence assessments, CD4 counts, Virologic failure, Combination antiretroviral therapy (cART), Antiretroviral agents -- Therapeutic use, HIV infections -- Treatment
Citation
Bisson, G. P. et al. 2008. Pharmacy refill adherence compared with CD4 count changes for monitoring HIV-infected adults on antiretroviral therapy. PLoS Med, 5(5), e109:777-789
doi:10.1371/journal.pmed. 0050109