Self-Reported Side Effects and Adherence to Antiretroviral Therapy in HIV-Infected Pregnant Women under Option B+: A Prospective Study
Identifieur interne : 000E14 ( Main/Exploration ); précédent : 000E13; suivant : 000E15Self-Reported Side Effects and Adherence to Antiretroviral Therapy in HIV-Infected Pregnant Women under Option B+: A Prospective Study
Auteurs : Tamsin Phillips [Afrique du Sud] ; Annibale Cois [Afrique du Sud] ; Robert H. Remien [États-Unis] ; Claude A. Mellins [États-Unis] ; James A. Mcintyre [Afrique du Sud] ; Greg Petro [Afrique du Sud] ; Elaine J. Abrams [États-Unis] ; Landon Myer [Afrique du Sud]Source :
- PLoS ONE [ 1932-6203 ] ; 2016.
Abstract
Antiretroviral therapy (ART) regimens containing efavirenz (EFV) are recommended as part of universal ART for pregnant and breastfeeding women. EFV may have appreciable side effects (SE), and ART adherence in pregnancy is a major concern, but little is known about ART SE and associations with adherence in pregnancy.
We investigated the distribution of patient-reported SE (based on Division of AIDS categories) and the association of SE with missed ART doses in a cohort of 517 women starting EFV+3TC/FTC+TDF during pregnancy. In analysis, SE were considered in terms of their overall frequency, by systems category, and by latent classes.
Overall 97% of women reported experiencing at least one SE after ART initiation, with 48% experiencing more than five SE. Gastrointestinal, central nervous system, systemic and skin SE were reported by 81%, 85%, 79% and 31% of women, respectively, with considerable overlap across groups. At least one missed dose was reported by 32% of women. In multivariable models, ART non-adherence was associated with systemic SE compared to other systems categories, and measures of the overall burden of SE experienced were most strongly associated with missed ART doses.
These data demonstrate very high levels of SE in pregnant women initiating EFV-based ART and a strong association between SE burden and ART adherence. ART regimens with reduced SE profiles may enhance adherence, and as countries expand universal ART for all adult patients, counseling must include preparation for ART SE.
Url:
DOI: 10.1371/journal.pone.0163079
PubMed: 27760126
PubMed Central: 5070813
Affiliations:
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Africa</addr-line></nlm:aff><country xml:lang="fr">Afrique du Sud</country><wicri:regionArea>Centre for Infectious Diseases Epidemiology & Research, University of Cape Town, Cape Town</wicri:regionArea><wicri:noRegion>Cape Town</wicri:noRegion></affiliation></author><author><name sortKey="Remien, Robert H" sort="Remien, Robert H" uniqKey="Remien R" first="Robert H." last="Remien">Robert H. Remien</name><affiliation wicri:level="4"><nlm:aff id="aff003"><addr-line>HIV Center for Clinical and Behavioral Studies, New York State Psychiatric Institute, Columbia University, New York, NY, United States of America</addr-line></nlm:aff><country xml:lang="fr">États-Unis</country><wicri:regionArea>HIV Center for Clinical and Behavioral Studies, New York State Psychiatric Institute, Columbia University, New York, NY</wicri:regionArea><placeName><region type="state">État de New York</region><settlement type="city">New York</settlement></placeName><orgName type="university">Université Columbia</orgName></affiliation></author><author><name sortKey="Mellins, Claude A" sort="Mellins, Claude A" uniqKey="Mellins C" first="Claude A." last="Mellins">Claude A. Mellins</name><affiliation wicri:level="4"><nlm:aff id="aff003"><addr-line>HIV Center for Clinical and Behavioral Studies, New York State Psychiatric Institute, Columbia University, New York, NY, United States of America</addr-line></nlm:aff><country xml:lang="fr">États-Unis</country><wicri:regionArea>HIV Center for Clinical and Behavioral Studies, New York State Psychiatric Institute, Columbia University, New York, NY</wicri:regionArea><placeName><region type="state">État de New York</region><settlement type="city">New York</settlement></placeName><orgName type="university">Université Columbia</orgName></affiliation></author><author><name sortKey="Mcintyre, James A" sort="Mcintyre, James A" uniqKey="Mcintyre J" first="James A." last="Mcintyre">James A. 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Abrams</name><affiliation wicri:level="4"><nlm:aff id="aff007"><addr-line>ICAP, Columbia University, Mailman School of Public Health, New York, NY, United States of America</addr-line></nlm:aff><country xml:lang="fr">États-Unis</country><wicri:regionArea>ICAP, Columbia University, Mailman School of Public Health, New York, NY</wicri:regionArea><placeName><region type="state">État de New York</region><settlement type="city">New York</settlement></placeName><orgName type="university">Université Columbia</orgName></affiliation><affiliation wicri:level="4"><nlm:aff id="aff008"><addr-line>College of Physicians & Surgeons, Columbia University, New York, NY, United States of America</addr-line></nlm:aff><country xml:lang="fr">États-Unis</country><wicri:regionArea>College of Physicians & Surgeons, Columbia University, New York, NY</wicri:regionArea><placeName><region type="state">État de New York</region><settlement type="city">New York</settlement></placeName><orgName type="university">Université Columbia</orgName></affiliation></author><author><name sortKey="Myer, Landon" sort="Myer, Landon" uniqKey="Myer L" first="Landon" last="Myer">Landon Myer</name><affiliation wicri:level="1"><nlm:aff id="aff001"><addr-line>Division of Epidemiology & Biostatistics, University of Cape Town, Cape Town, South Africa</addr-line></nlm:aff><country xml:lang="fr">Afrique du Sud</country><wicri:regionArea>Division of Epidemiology & Biostatistics, University of Cape Town, Cape Town</wicri:regionArea><wicri:noRegion>Cape Town</wicri:noRegion></affiliation><affiliation wicri:level="1"><nlm:aff id="aff002"><addr-line>Centre for Infectious Diseases Epidemiology & Research, University of Cape Town, Cape Town, South Africa</addr-line></nlm:aff><country xml:lang="fr">Afrique du Sud</country><wicri:regionArea>Centre for Infectious Diseases Epidemiology & Research, University of Cape Town, Cape Town</wicri:regionArea><wicri:noRegion>Cape Town</wicri:noRegion></affiliation></author></analytic><series><title level="j">PLoS ONE</title><idno type="eISSN">1932-6203</idno><imprint><date when="2016">2016</date></imprint></series></biblStruct></sourceDesc></fileDesc><profileDesc><textClass></textClass></profileDesc></teiHeader><front><div type="abstract" xml:lang="en"><sec id="sec001"><title>Background</title><p>Antiretroviral therapy (ART) regimens containing efavirenz (EFV) are recommended as part of universal ART for pregnant and breastfeeding women. EFV may have appreciable side effects (SE), and ART adherence in pregnancy is a major concern, but little is known about ART SE and associations with adherence in pregnancy.</p></sec><sec id="sec002"><title>Methods</title><p>We investigated the distribution of patient-reported SE (based on Division of AIDS categories) and the association of SE with missed ART doses in a cohort of 517 women starting EFV+3TC/FTC+TDF during pregnancy. In analysis, SE were considered in terms of their overall frequency, by systems category, and by latent classes.</p></sec><sec id="sec003"><title>Results</title><p>Overall 97% of women reported experiencing at least one SE after ART initiation, with 48% experiencing more than five SE. Gastrointestinal, central nervous system, systemic and skin SE were reported by 81%, 85%, 79% and 31% of women, respectively, with considerable overlap across groups. At least one missed dose was reported by 32% of women. In multivariable models, ART non-adherence was associated with systemic SE compared to other systems categories, and measures of the overall burden of SE experienced were most strongly associated with missed ART doses.</p></sec><sec id="sec004"><title>Conclusion</title><p>These data demonstrate very high levels of SE in pregnant women initiating EFV-based ART and a strong association between SE burden and ART adherence. ART regimens with reduced SE profiles may enhance adherence, and as countries expand universal ART for all adult patients, counseling must include preparation for ART SE.</p></sec></div></front><back><div1 type="bibliography"><listBibl><biblStruct></biblStruct><biblStruct><analytic><author><name sortKey="Nachega, Jb" uniqKey="Nachega J">JB Nachega</name></author><author><name sortKey="Uthman, Oa" uniqKey="Uthman O">OA Uthman</name></author><author><name sortKey="Anderson, J" uniqKey="Anderson J">J Anderson</name></author><author><name sortKey="Peltzer, K" uniqKey="Peltzer K">K Peltzer</name></author><author><name sortKey="Wampold, S" uniqKey="Wampold S">S Wampold</name></author><author><name sortKey="Cotton, Mf" uniqKey="Cotton M">MF Cotton</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Hodgson, I" uniqKey="Hodgson I">I Hodgson</name></author><author><name sortKey="Plummer, Ml" uniqKey="Plummer M">ML Plummer</name></author><author><name 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last="Phillips">Tamsin Phillips</name></noRegion><name sortKey="Cois, Annibale" sort="Cois, Annibale" uniqKey="Cois A" first="Annibale" last="Cois">Annibale Cois</name><name sortKey="Cois, Annibale" sort="Cois, Annibale" uniqKey="Cois A" first="Annibale" last="Cois">Annibale Cois</name><name sortKey="Mcintyre, James A" sort="Mcintyre, James A" uniqKey="Mcintyre J" first="James A." last="Mcintyre">James A. 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Remien</name></region><name sortKey="Abrams, Elaine J" sort="Abrams, Elaine J" uniqKey="Abrams E" first="Elaine J." last="Abrams">Elaine J. Abrams</name><name sortKey="Abrams, Elaine J" sort="Abrams, Elaine J" uniqKey="Abrams E" first="Elaine J." last="Abrams">Elaine J. Abrams</name><name sortKey="Mellins, Claude A" sort="Mellins, Claude A" uniqKey="Mellins C" first="Claude A." last="Mellins">Claude A. Mellins</name></country></tree></affiliations></record>Pour manipuler ce document sous Unix (Dilib)
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