@article{fdi:010062462,
  title = {{P}atterns of adherence to antiretroviral therapy and {HIV} drug resistance over time in the {S}tratall {ANRS} 12110/{ESTHER} trial in {C}ameroon},
  author = {{M}eresse, {M}. and {M}arch, {L}. and {K}ouanfack, {C}. and {B}onono, {R}. {C}. and {B}oyer, {S}. and {L}aborde-{B}alen, {G}. and {A}ghokeng {F}obang, {A}velin and {S}uzan-{M}onti, {M}. and {D}elaporte, {E}ric and {S}pire, {B}. and {C}arrieri, {M}. {P}. and {L}aurent, {C}hristian},
  editor = {},
  language = {{ENG}},
  abstract = {{O}bjectives {T}he emergence of {HIV} drug resistance is a crucial issue in {A}frica, where second-line antiretroviral therapy ({ART}) is limited, expensive and complex. {W}e assessed the association between adherence patterns and resistance emergence over time, using an adherence measure that distinguishes low adherence from treatment interruptions, in rural {C}ameroon. {M}ethods {W}e performed a cohort study among patients receiving nonnucleoside reverse transcriptase inhibitor ({NNRTI})-based {ART} in nine district hospitals, using data from the {S}tratall trial (2006-2010). {G}enotypic mutations associated with antiretroviral drug resistance were assessed when 6-monthly {HIV} viral loads were >5000 {HIV}-1 {RNA} copies/m{L}. {ART} adherence data were collected using face-to-face questionnaires. {C}ombined 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. {M}ultivariate logistic regression and {C}ox models were used to assess the association between adherence patterns and early (at 6 months) and late (after 6 months) resistance emergence, respectively. {R}esults {A}mong 456 participants (71% women; median age 37 years), 45 developed {HIV} drug resistance (18 early and 27 late). {E}arly 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]. {E}arly treatment interruptions were also associated with late resistance [adjusted hazard ratio (95% confidence interval) 3.72 (1.27-10.92)]. {C}onclusions {T}he emergence of {HIV} drug resistance on first-line {NNRTI}-based regimens was associated with different patterns of adherence over time. {E}nsuring optimal early adherence through specific interventions, adequate management of drug stocks, and viral load monitoring is a clinical and public health priority in {A}frica.},
  keywords = {adherence ; {A}frica ; antiretroviral ; {HIV} ; resistance ; {CAMEROUN}},
  booktitle = {},
  journal = {{H}iv {M}edicine},
  volume = {15},
  numero = {8},
  pages = {478--487},
  ISSN = {1464-2662},
  year = {2014},
  DOI = {10.1111/hiv.12140},
  URL = {https://www.documentation.ird.fr/hor/fdi:010062462},
}