Adherence Measured Using Electronic Dose Monitoring is Associated with Emergent Antiretroviral Resistance and Poor Outcomes in People with Human Immunodeficiency Virus/AIDS and Multidrug-Resistant Tuberculosis

Medication adherence is known to challenge treatment of human immunodeficiency virus (HIV)/AIDS and multidrug-resistant tuberculosis (MDR-TB). We hypothesized that adherence using electronic dose monitoring (EDM) would identify an antiretroviral therapy (ART) adherence threshold for emergent ART res...

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Veröffentlicht in:Clinical infectious diseases Jg. 75; H. 9; S. 1489
Hauptverfasser: Bateman, Mark, Wolf, Allison, Chimukangara, Benjamin, Brust, James C M, Lessells, Richard, Amico, Rivet, Boodhram, Resha, Singh, Nalini, Orrell, Catherine, Friedland, Gerald, Naidoo, Kogieleum, Padayatchi, Nesri, O'Donnell, Max R
Format: Journal Article
Sprache:Englisch
Veröffentlicht: United States 29.10.2022
Schlagworte:
Acquired Immunodeficiency Syndrome - drug therapy
Adult
Anti-Retroviral Agents - therapeutic use
Antitubercular Agents - therapeutic use
Electronics
HIV
HIV Infections
Humans
Prospective Studies
South Africa
Tuberculosis, Multidrug-Resistant - drug therapy
South Africa
emergent resistance
South Africa
electronic dose monitoring
antiretroviral adherence
patients with HIV/AIDS and multidrug-resistant tuberculosis
ISSN:1537-6591, 1537-6591
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Zusammenfassung:Medication adherence is known to challenge treatment of human immunodeficiency virus (HIV)/AIDS and multidrug-resistant tuberculosis (MDR-TB). We hypothesized that adherence using electronic dose monitoring (EDM) would identify an antiretroviral therapy (ART) adherence threshold for emergent ART resistance and predict treatment outcomes in patients with MDR-TB and HIV on ART and bedaquiline-containing TB regimens. A prospective cohort of adults with MDR-TB and HIV on ART and initiating MDR-TB treatment with bedaquiline were enrolled at a public hospital in KwaZulu-Natal, South Africa (PRAXIS Study). Participants received separate EDM devices that measure adherence to bedaquiline and ART (nevirapine or lopinavir/ritonavir). Adherence was calculated cumulatively over 6 months. Participants were followed through completion of MDR-TB treatment. HIV genome sequencing was performed at baseline and 2 and 6 months on samples with HIV RNA ≥1000 copies/mL. From November 2016 through February 2018, 198 persons with MDR-TB and HIV were enrolled and followed (median, 17.2 months; interquartile range, 12.2-19.6). Eleven percent had baseline ART resistance mutations, and 7.5% developed emergent ART resistance at 6 months. ART adherence was independently associated with ART resistance and mortality. Modeling identified a significant (P < .001), linear association between ART adherence and emergent resistance, suggesting a strong association without a specific threshold. Our findings highlight the need for ART resistance testing, especially in patients with MDR-TB and HIV, which is currently not the standard of care in resource-limited settings. Despite short follow-up duration, reduced ART adherence was significantly associated with emergent resistance and increased mortality. NCT03162107.
Bibliographie:ObjectType-Article-1
SourceType-Scholarly Journals-1
ObjectType-Feature-2
content type line 23
ISSN:1537-6591
1537-6591
DOI:10.1093/cid/ciac232