Poor quality of life and incomplete self-reported adherence predict second-line ART virological failure in resource-limited settings

ABSTRACT

We evaluated health-related quality of life (QoL) and self-reported incomplete adherence as predictors of early second-line antiretroviral (ART) virological failure (VF). ACTG A5273 study participants completed the ACTG SF-21 measure which has 8 QoL domains. We used exact logistic regression to assess the association of QoL at baseline and week 4 with early VF adjusted for self-reported adherence. Of 500 individuals (51% women, median age 39 years) in this analysis, 79% and 75% self-reported complete adherence (no missing doses in the past month) at weeks 4 and 24, respectively. Early VF was experienced by 7% and more common among those who self-reported incomplete adherence. Participants with low week 4 QoL scores had higher rates of early VF than participants with high scores. After adjusting for self-reported adherence at week 4, VL and CD4 at baseline, cognitive functioning, pain and mental health domains were significantly associated with subsequent early VF. In this post-hoc analysis, poorer QoL adds to self-reported incomplete adherence after 4 weeks of second-line ART in predicting VF at week 24. Evaluation is needed to assess whether individuals with poorer QoL might be targeted for greater support to reduce risk of VF.

Trial registration: ClinicalTrials.gov identifier: NCT01352715.

KEYWORDS:

• HIV
• quality of life
• virological failure
• adherence
• second-line therapy
• antiretroviral therapy

Acknowledgments

Presented in part at the Conference of Retroviruses and Opportunistic Infections (CROI) 2019, Seattle, 06 March 2019. We thank the study participants and the other members of the ACTG A5273 Study Group.

Disclosure statement

No potential conflict of interest was reported by the author(s).

Additional information

Funding

ACTG A5273 study was supported by the National Institute of Allergy and Infectious Diseases (award number U01AI068636), the National Institute of Mental Health (NIMH), and the National Institute of Dental and Craniofacial Research (NIDCR). The study was funded via the following grants: AI069432, AI069438, AI069481, 2UM1AI069423 (including a subcontract to the Pittsburgh Virology Specialty Laboratory), UM1 AI069471, and UM1 AI068634 (ACTG Statistical and Data Management Center) and the Investigator-Initiated Studies Program of Merck Sharp & Dohme. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institute of Allergy and Infectious Diseases, the National Institutes of Health, or Merck Sharp & Dohme. Abbott Laboratories, Gilead Sciences, ViiV Healthcare/GSK, and Merck Sharp & Dohme provided the study drugs.