%0 Journal Article
%9 ACL : Articles dans des revues avec comité de lecture répertoriées par l'AERES
%A Meresse, M.
%A Carrieri, M. P.
%A Laurent, Christian
%A Kouanfack, C.
%A Protopopescu, C.
%A Blanche, J.
%A Cohen, J.
%A Laborde-Balen, G.
%A Aghokeng Fobang, Avelin
%A Spire, B.
%A Moatti, Jean-Paul
%A Delaporte, Eric
%A Boyer, S.
%T Time patterns of adherence and long-term virological response to non-nucleoside reverse transcriptase inhibitor regimens in the Stratall ANRS 12110/ESTHER trial in Cameroon
%D 2013
%L fdi:010061788
%G ENG
%J Antiviral Therapy
%@ 1359-6535
%K CAMEROUN
%M ISI:000329575900004
%N 1
%P 29-37
%R 10.3851/imp2535
%U https://www.documentation.ird.fr/hor/fdi:010061788
%> https://www.documentation.ird.fr/intranet/publi/2014/03/010061788.pdf
%V 18
%W Horizon (IRD)
%X Background: Although treatment adherence is a major challenge in sub-Saharan Africa, it is still unknown which longitudinal patterns of adherence are the most detrimental to long-term virological response to non-nucleoside reverse transcriptase inhibitor (NNRTI) regimens. This analysis aimed to study the influence of different time patterns of adherence on virological failure after 24 months of treatment in Cameroon. Methods: Antiretroviral therapy (ART) adherence data were collected using face-to-face questionnaires administered at months 1, 3, 6, 12, 18 and 24. Virological failure was defined as viral load > 40 copies/ml at month 18 and/or 24. Two combined indicators of early adherence (months 1, 3 and 6) and adherence during the maintenance phase (months 12, 18 and 24) were designed to classify patients as always adherent during the early or maintenance phase, non-adherent at least once and having interrupted ART for > 2 days at least once at any visit during either of these two phases. Results: Virological failure occurred in 107 (42%) of the 254 patients included in the analysis. In the early and maintenance phases, 84% and 76%, respectively, were always adherent, 5% and 5% were non-adherent and 11% and 20% experienced >= 1 treatment interruption. Early non-adherence was independently associated with virological failure (adjusted OR 7.2 [95% CI 1.5, 34.6]), while only treatment interruptions had a significant impact on virological failure during the maintenance phase (adjusted OR 2.1 [95% CI 1.1, 4.4]). Conclusions: ART NNRTI-regimens used in sub-Saharan Africa seem to 'forgive' deviations from good adherence during the maintenance phase. Optimizing adherence in the early months of treatment remains crucial, especially in a setting of poor health care infrastructure and resources.
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