title: Timeliness of clinic attendance is a good predictor of virological response and resistance to antiretroviral drugs in HIV-infected patients.
abstract: BACKGROUND
  Ensuring long-term adherence to therapy is essential for the success of HIV treatment. As access to viral load monitoring and genotyping is poor in resource-limited settings, a simple tool to monitor adherence is needed. We assessed the relationship between an indicator based on timeliness of clinic attendance and virological response and HIV drug resistance.
  
  
  METHODS
  Data from 7 virological cross-sectional studies were pooled. An adherence indicator was calculated as the number of appointments attended with delay divided by the number of months between antiretroviral treatment (ART) initiation and date of virological testing and multiplying this by 100. Delays of 1 or more to 5 or more days were considered in turn. Multivariate random-intercept logistic regression was fitted to examine the effect on outcomes, separately for adults and children.
  
  
  RESULTS
  A total of 3580 adults and 253 children were included. Adults were followed for a median of 26.0 months (IQR 12.8-45.0) and attended a median of 24 visits (IQR 13-34). The 1-day delay adherence indicator was strongly associated with viral load suppression (OR 0.96, 95% CI 0.95-0.97 per unit increase), virological failure (OR 1.05, 95% CI 1.03-1.06) and HIV drug resistance (OR 1.03, 95% CI 1.01-1.05) after adjusting for initial age and CD4 count, previous ART experience, type of regimen and Tuberculosis diagnosis at start of therapy. Similar results were observed in children.
  
  
  CONCLUSIONS
  An adherence indicator based on timeliness of clinic attendance predicts strongly both virological response and drug resistance, and could help to timely identify non-adherent patients in settings where viral load monitoring is not available.
authors.affiliation: Epicentre, Paris, France. mathieu.bastard@geneva.msf.org
authors.forename: Mathieu
authors.initials: M
authors.lastname: Bastard
authors.forename: Loretxu
authors.initials: L
authors.lastname: Pinoges
authors.forename: Suna
authors.initials: S
authors.lastname: Balkan
authors.forename: Elisabeth
authors.initials: E
authors.lastname: Szumilin
authors.forename: Cecilia
authors.initials: C
authors.lastname: Ferreyra
authors.forename: Mar
authors.initials: M
authors.lastname: Pujades-Rodriguez
mesh_terms: D000328:Adult; D044966:Anti-Retroviral Agents / Q000008:administration & dosage*; D023241:Antiretroviral Therapy, Highly Active; D001071:Appointments and Schedules; D002648:Child; D002675:Child, Preschool; D024882:Drug Resistance, Viral / Q000235:genetics*; D005260:Female; D005838:Genotype; D015658:HIV Infections / Q000188:drug therapy* / Q000473:pathology; D015497:HIV-1 / Q000187:drug effects / Q000472:pathogenicity; D006801:Humans; D008297:Male; D019562:Viral Load / Q000235:genetics*
chemical_list: D044966:Anti-Retroviral Agents