title: Risk factors for virological failure and subtherapeutic antiretroviral drug concentrations in HIV-positive adults treated in rural northwestern Uganda.
abstract: BACKGROUND
  Little is known about immunovirological treatment outcomes and adherence in HIV/AIDS patients on antiretroviral therapy (ART) treated using a simplified management approach in rural areas of developing countries, or about the main factors influencing those outcomes in clinical practice.
  
  
  METHODS
  Cross-sectional immunovirological, pharmacological, and adherence outcomes were evaluated in all patients alive and on fixed-dose ART combinations for 24 months, and in a random sample of those treated for 12 months. Risk factors for virological failure (>1,000 copies/ml) and subtherapeutic antiretroviral (ARV) concentrations were investigated with multiple logistic regression.
  
  
  RESULTS
  At 12 and 24 months of ART, 72% (n = 701) and 70% (n = 369) of patients, respectively, were alive and in care. About 8% and 38% of patients, respectively, were diagnosed with immunological failure; and 75% and 72% of patients, respectively, had undetectable HIV RNA (<400 copies/ml). Risk factors for virological failure (>1,000 copies/ml) were poor adherence, tuberculosis diagnosed after ART initiation, subtherapeutic NNRTI concentrations, general clinical symptoms, and lower weight than at baseline. About 14% of patients had low ARV plasma concentrations. Digestive symptoms and poor adherence to ART were risk factors for low ARV plasma concentrations.
  
  
  CONCLUSIONS
  Efforts to improve both access to care and patient management to achieve better immunological and virological outcomes on ART are necessary to maximize the duration of first-line therapy.
authors.affiliation: HIV/AIDS Department, Epicentre, Paris, France. laurence.ahoua@epicentre.msf.org
authors.forename: Laurence
authors.initials: L
authors.lastname: Ahoua
authors.forename: Gunar
authors.initials: G
authors.lastname: Guenther
authors.forename: Loretxu
authors.initials: L
authors.lastname: Pinoges
authors.forename: Paul
authors.initials: P
authors.lastname: Anguzu
authors.forename: Marie-Laure
authors.initials: ML
authors.lastname: Chaix
authors.forename: Clotilde
authors.initials: C
authors.lastname: Le Tiec
authors.forename: Suna
authors.initials: S
authors.lastname: Balkan
authors.forename: David
authors.initials: D
authors.lastname: Olson
authors.forename: Charles
authors.initials: C
authors.lastname: Olaro
authors.forename: Mar
authors.initials: M
authors.lastname: Pujades-Rodríguez
mesh_terms: D000328:Adult; D019380:Anti-HIV Agents / Q000097:blood / Q000627:therapeutic use*; D003430:Cross-Sectional Studies; D003906:Developing Countries; D024882:Drug Resistance, Viral / Q000235:genetics; D005260:Female; D006679:HIV Seropositivity / Q000097:blood / Q000188:drug therapy* / Q000453:epidemiology; D015497:HIV-1 / Q000187:drug effects / Q000235:genetics; D006801:Humans; D016015:Logistic Models; D008297:Male; D010349:Patient Compliance / Q000706:statistics & numerical data; D012367:RNA, Viral / Q000097:blood; D012189:Retrospective Studies; D012307:Risk Factors; D012424:Rural Population; D016896:Treatment Outcome; D014454:Uganda / Q000453:epidemiology
chemical_list: D019380:Anti-HIV Agents; D012367:RNA, Viral