title: Patterns of adherence to antiretroviral therapy and HIV drug resistance over time in the Stratall ANRS 12110/ESTHER trial in Cameroon.
abstract: The emergence of HIV drug resistance is a crucial issue in Africa, where second-line antiretroviral therapy (ART) is limited, expensive and complex. We assessed the association between adherence patterns and resistance emergence over time, using an adherence measure that distinguishes low adherence from treatment interruptions, in rural Cameroon.
  
  
  
  We performed a cohort study among patients receiving nonnucleoside reverse transcriptase inhibitor (NNRTI)-based ART in nine district hospitals, using data from the Stratall trial (2006-2010). Genotypic mutations associated with antiretroviral drug resistance were assessed when 6-monthly HIV viral loads were > 5000 HIV-1 RNA copies/mL. ART adherence data were collected using face-to-face questionnaires. Combined indicators of early (1-3 months) and late (6 months to t - 1; t is the time point when the resistance had been detected) adherence were constructed. Multivariate logistic regression and Cox models were used to assess the association between adherence patterns and early (at 6 months) and late (after 6 months) resistance emergence, respectively.
  
  
  
  Among 456 participants (71% women; median age 37 years), 45 developed HIV drug resistance (18 early and 27 late). Early low adherence (< 80%) and treatment interruptions (> 2 days) were associated with early resistance [adjusted odds ratio (95% confidence interval) 8.51 (1.30-55.61) and 5.25 (1.45-18.95), respectively]. Early treatment interruptions were also associated with late resistance [adjusted hazard ratio (95% confidence interval) 3.72 (1.27-10.92)].
  
  
  
  The emergence of HIV drug resistance on first-line NNRTI-based regimens was associated with different patterns of adherence over time. Ensuring optimal early adherence through specific interventions, adequate management of drug stocks, and viral load monitoring is a clinical and public health priority in Africa.
authors.affiliation: INSERM, UMR912 'Economics and Social Sciences Applied to Health & Analysis of Medical Information' (SESSTIM), Marseille, France; Aix Marseille University, UMR_S912, IRD, Marseille, France; ORS PACA, Southeastern Health Regional Observatory, Marseille, France.
authors.forename: M
authors.initials: M
authors.lastname: Meresse
authors.forename: L
authors.initials: L
authors.lastname: March
authors.forename: C
authors.initials: C
authors.lastname: Kouanfack
authors.forename: R C
authors.initials: RC
authors.lastname: Bonono
authors.forename: S
authors.initials: S
authors.lastname: Boyer
authors.forename: G
authors.initials: G
authors.lastname: Laborde-Balen
authors.forename: A
authors.initials: A
authors.lastname: Aghokeng
authors.forename: M
authors.initials: M
authors.lastname: Suzan-Monti
authors.forename: E
authors.initials: E
authors.lastname: Delaporte
authors.forename: B
authors.initials: B
authors.lastname: Spire
authors.forename: M P
authors.initials: MP
authors.lastname: Carrieri
authors.forename: C
authors.initials: C
authors.lastname: Laurent
mesh_terms: D000328:Adult; D044966:Anti-Retroviral Agents / Q000494:pharmacology / Q000627:therapeutic use*; D023241:Antiretroviral Therapy, Highly Active / Q000379:methods*; D002163:Cameroon; D015331:Cohort Studies; D024882:Drug Resistance, Viral; D005260:Female; D005838:Genotype; D015658:HIV Infections / Q000188:drug therapy* / Q000821:virology; D015497:HIV-1 / Q000187:drug effects* / Q000235:genetics; D006767:Hospitals, District; D006801:Humans; D007407:Interviews as Topic; D008297:Male; D055118:Medication Adherence; D013997:Time Factors; D019562:Viral Load
chemical_list: D044966:Anti-Retroviral Agents
keywords: Africa; HIV; adherence; antiretroviral; resistance