BACKGROUND: High levels of adherence to antiretroviral therapy are considered necessary to achieve viral suppression. We analyzed data from a cohort of HIV-infected children who were <2 years of age receiving protease inhibitor-based antiretroviral therapy to investigate associations between viral suppression and adherence ascertained using different methods. METHODS: Data were from the prerandomization phase of a clinical trial in South Africa of HIV-infected children initiating either ritonavir-boosted lopinavir (LPV/r) or ritonavir-based antiretroviral therapy. At scheduled visits during the first 24 weeks of enrollment, study pharmacists measured quantities of medications returned to the clinic. Caregivers answered questionnaires on missed doses and adherence barriers. Associations between adherence and viral suppression (HIV-1 RNA <400 copies/mL) were investigated by regimen. RESULTS: By 24 weeks, 197 of the 269 (73%) children achieved viral suppression. There was no association between viral suppression and caregiver reported missed doses or adherence barriers. For children receiving the LPV/r-based regimen, medication return adherence to each of the 3 drugs in the regimen (LPV/r, lamivudine or stavudine) individually or together was associated with viral suppression at different adherence thresholds. For example, <85% adherence to any of the 3 medications significantly increased odds of lack of viral suppression (odds ratio: 2.30, 95% confidence interval: 1.30-4.07, P = 0.004). In contrast, for children receiving the ritonavir-based regimen, there was no consistent pattern of association between medication return and viral suppression. CONCLUSIONS: Caregiver reports of missed doses did not predict virologic response to treatment. Pharmacist medication reconciliation correlated strongly with virologic response for children taking a LPV/r-based regimen and appears to be a valid method for measuring pediatric adherence.
BACKGROUND: High levels of adherence to antiretroviral therapy are considered necessary to achieve viral suppression. We analyzed data from a cohort of HIV-infectedchildren who were <2 years of age receiving protease inhibitor-based antiretroviral therapy to investigate associations between viral suppression and adherence ascertained using different methods. METHODS: Data were from the prerandomization phase of a clinical trial in South Africa of HIV-infectedchildren initiating either ritonavir-boosted lopinavir (LPV/r) or ritonavir-based antiretroviral therapy. At scheduled visits during the first 24 weeks of enrollment, study pharmacists measured quantities of medications returned to the clinic. Caregivers answered questionnaires on missed doses and adherence barriers. Associations between adherence and viral suppression (HIV-1 RNA <400 copies/mL) were investigated by regimen. RESULTS: By 24 weeks, 197 of the 269 (73%) children achieved viral suppression. There was no association between viral suppression and caregiver reported missed doses or adherence barriers. For children receiving the LPV/r-based regimen, medication return adherence to each of the 3 drugs in the regimen (LPV/r, lamivudine or stavudine) individually or together was associated with viral suppression at different adherence thresholds. For example, <85% adherence to any of the 3 medications significantly increased odds of lack of viral suppression (odds ratio: 2.30, 95% confidence interval: 1.30-4.07, P = 0.004). In contrast, for children receiving the ritonavir-based regimen, there was no consistent pattern of association between medication return and viral suppression. CONCLUSIONS: Caregiver reports of missed doses did not predict virologic response to treatment. Pharmacist medication reconciliation correlated strongly with virologic response for children taking a LPV/r-based regimen and appears to be a valid method for measuring pediatric adherence.
Authors: D L Paterson; S Swindells; J Mohr; M Brester; E N Vergis; C Squier; M M Wagener; N Singh Journal: Ann Intern Med Date: 2000-07-04 Impact factor: 25.391
Authors: Robert Gross; Benita Yip; Vincent Lo Re; Evan Wood; Christopher S Alexander; P Richard Harrigan; David R Bangsberg; Julio S G Montaner; Robert S Hogg Journal: J Infect Dis Date: 2006-09-12 Impact factor: 5.226
Authors: Alexandra D Müller; Stefan Bode; Landon Myer; Paul Roux; Nicole von Steinbüchel Journal: Pediatr Infect Dis J Date: 2008-03 Impact factor: 2.129
Authors: Ellen G Chadwick; Edmund V Capparelli; Ram Yogev; Jorge A Pinto; Brian Robbins; John H Rodman; Jie Chen; Paul Palumbo; Leslie Serchuck; Elizabeth Smith; Michael Hughes Journal: AIDS Date: 2008-01-11 Impact factor: 4.177
Authors: Kunjal Patel; Miguel A Hernán; Paige L Williams; John D Seeger; Kenneth McIntosh; Russell B Van Dyke; George R Seage Journal: Clin Infect Dis Date: 2008-02-15 Impact factor: 9.079
Authors: Deborah Persaud; Stuart C Ray; Joleen Kajdas; Aima Ahonkhai; George K Siberry; Kimberly Ferguson; Carrie Ziemniak; Thomas C Quinn; Joseph P Casazza; Steven Zeichner; Stephen J Gange; Douglas C Watson Journal: AIDS Res Hum Retroviruses Date: 2007-03 Impact factor: 2.205
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