en
Scientific article
English

Adherence to antiretroviral therapy assessed by drug level monitoring and self-report in Cameroon

Published inJournal of acquired immune deficiency syndromes, vol. 48, no. 2, p. 216-219
Publication date2008-06-01
Abstract

Objectives: To compare adherence to antiretroviral therapy using drug level monitoring and self-report and to explore the relation between these 2 methods and viral load measurements.

Methods: Sixty patients received a fixed-dose combination of nevirapine, stavudine, and lamivudine in a clinical study in Cameroon. Adherence was assessed every 6 months until month 36 by nevirapine minimal plasma concentration and self-report. Plasma HIV-1 viral load was determined at the same time. Analyses included 159 complete observations.

Results: The proportion of patients labeled as "adherent" was significantly lower using nevirapine monitoring (88.7%, 95% confidence interval [CI]: 82.7 to 93.2) than self-report (97.5%, CI: 93.7 to 99.3; P = 0.002). Virologic failure was associated with the nevirapine concentration (adjusted odds ratio [aOR] = 4.43; P = 0.018) but not with the self-reported adherence (aOR = 0.84; P = 0.9). As compared with the virologic outcome, the sensitivity of nevirapine level monitoring for predicting inadequate adherence was 20.5%, the specificity was 91.7%, the positive predictive value was 44.4%, and the negative predictive value was 78.0%. For self-report, the respective values were 2.6%, 97.5%, 25.0%, and 75.5%.

Conclusions: Drug level monitoring provided a more reliable estimate of adherence than self-report. This method could be used in research settings. Operational research is required to define how to improve the accuracy of the self-report method because it is the most feasible method in clinical practice.

eng
Keywords
  • Adult
  • Anti-HIV Agents / therapeutic use
  • Drug Monitoring
  • Drug Therapy, Combination
  • Female
  • HIV Infections / blood
  • HIV Infections / drug therapy
  • HIV Infections / virology
  • Humans
  • Male
  • Nevirapine / blood
  • Patient Compliance
  • Viral Load
Affiliation Not a UNIGE publication
Research group
Citation (ISO format)
KOUANFACK, Charles et al. Adherence to antiretroviral therapy assessed by drug level monitoring and self-report in Cameroon. In: Journal of acquired immune deficiency syndromes, 2008, vol. 48, n° 2, p. 216–219. doi: 10.1097/QAI.0b013e3181743955
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Article (Published version)
accessLevelRestricted
Identifiers
ISSN of the journal1525-4135
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