Beyond clinical trials: Crosssectional associations of combination antiretroviral therapy with reports of multiple symptoms and nonadherence among adolescents in South Africa
Background. Studies investigating symptoms associated with combination antiretroviral therapy (cART) use among adolescents in resource-limited settings are rare beyond clinical trials. Identifying adolescents at risk of non-adherence is imperative for HIV/AIDS programming and controlling the epidemi...
| Main Authors: | , , , , |
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| Format: | Article |
| Language: | English |
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South African Medical Association
2017-11-01
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| Series: | South African Medical Journal |
| Online Access: | http://www.samj.org.za/index.php/samj/article/download/12102/8274 |
| _version_ | 1797331695532244992 |
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| author | H Natukunda L Cluver E Toska V Musiime A Yakubovich |
| author_facet | H Natukunda L Cluver E Toska V Musiime A Yakubovich |
| author_sort | H Natukunda |
| collection | DOAJ |
| description | Background. Studies investigating symptoms associated with combination antiretroviral therapy (cART) use among adolescents in resource-limited settings are rare beyond clinical trials. Identifying adolescents at risk of non-adherence is imperative for HIV/AIDS programming and controlling the epidemic in this key population.Objective. To examine which cART regimens were associated with reports of multiple symptoms and past-week non-adherence in a large community-traced sample of HIV-positive adolescents in South Africa (SA).Methods. A total of 1 175 HIV-positive ART-experienced adolescents aged 10 - 19 years attending 53 health facilities in the Eastern Cape Province, SA, were interviewed in 2014 - 2015. Ninety percent (n=1 059) were included in the study. Adolescents who reported no medication use and those with unclear or missing data were excluded from further analysis, resulting in a sample for analysis of n=501. Outcomes were reports of multiple symptoms (three or more symptoms in the past 6 months) and past-week ART non-adherence (<95% correct doses in the past week). Multivariable logistic regression analyses controlled for sociodemographic and HIV-related covariates in Stata 13/IC.Results. Of the adolescents included, 54.3% were female. The median age was 14 (interquartile range 12 - 16) years, and 66.5% were vertically infected. The prevalence of multiple symptoms was 59.7% (95% confidence interval (CI) 55.3 - 63.9). Independent of covariates, stavudine (d4T)-containing cART regimens and the fixed-dose combination of tenofovir (TDF) + emtricitabine (FTC) + efavirenz (EFV) were associated with more reports of multiple symptoms (adjusted odds ratio (aOR) 3.38; 95% CI 1.19 - 9.60 and aOR 2.67; 95% CI 1.21 - 5.88, respectively). Lopinavir/ritonavir (LPV/r)-containing regimens were associated with fewer reports of multiple symptoms (aOR 0.47; 95% CI 0.21 - 1.04). For EFV-based regimens, adolescents on d4T + lamivudine (3TC) + EFV were more likely to report multiple symptoms than those on TDF + FTC + EFV or those on abacavir (ABC) + 3TC + EFV (aOR 3.26; 95% CI 1.01 - 10.52, aOR 2.86; 95% CI 1.35 - 6.05 and aOR 1.08; 95% CI 0.64 - 1.82, respectively). However, only TDF + FTC + EFV cART was associated with lower levels of non-adherence among participants (aOR 0.44; 95% CI 0.21 - 0.93).Conclusions. Rates of multiple symptoms among HIV-positive ART-experienced adolescents were high. d4T-containing regimens and TDF + FTC + EFV were associated with more reports of multiple symptoms, whereas LPV/r-containing regimens were associated with fewer reports. However, adolescents on TDF + FTC + EFV were the most adherent subgroup. These findings support the World Health Organization-recommended discontinuation of d4T use, but also underscore the dilemma faced by clinicians when choosing between low-toxicity regimens and those that promote ART adherence, particularly among HIV-positive adolescents. |
| first_indexed | 2024-03-08T07:39:10Z |
| format | Article |
| id | doaj.art-7f7bb49d15c141d7ae410f4000cc4bac |
| institution | Directory Open Access Journal |
| issn | 0256-9574 2078-5135 |
| language | English |
| last_indexed | 2024-03-08T07:39:10Z |
| publishDate | 2017-11-01 |
| publisher | South African Medical Association |
| record_format | Article |
| series | South African Medical Journal |
| spelling | doaj.art-7f7bb49d15c141d7ae410f4000cc4bac2024-02-02T17:55:43ZengSouth African Medical AssociationSouth African Medical Journal0256-95742078-51352017-11-011071196597510.7196/SAMJ.2017.v107i11.12405Beyond clinical trials: Crosssectional associations of combination antiretroviral therapy with reports of multiple symptoms and nonadherence among adolescents in South AfricaH NatukundaL CluverE ToskaV MusiimeA YakubovichBackground. Studies investigating symptoms associated with combination antiretroviral therapy (cART) use among adolescents in resource-limited settings are rare beyond clinical trials. Identifying adolescents at risk of non-adherence is imperative for HIV/AIDS programming and controlling the epidemic in this key population.Objective. To examine which cART regimens were associated with reports of multiple symptoms and past-week non-adherence in a large community-traced sample of HIV-positive adolescents in South Africa (SA).Methods. A total of 1 175 HIV-positive ART-experienced adolescents aged 10 - 19 years attending 53 health facilities in the Eastern Cape Province, SA, were interviewed in 2014 - 2015. Ninety percent (n=1 059) were included in the study. Adolescents who reported no medication use and those with unclear or missing data were excluded from further analysis, resulting in a sample for analysis of n=501. Outcomes were reports of multiple symptoms (three or more symptoms in the past 6 months) and past-week ART non-adherence (<95% correct doses in the past week). Multivariable logistic regression analyses controlled for sociodemographic and HIV-related covariates in Stata 13/IC.Results. Of the adolescents included, 54.3% were female. The median age was 14 (interquartile range 12 - 16) years, and 66.5% were vertically infected. The prevalence of multiple symptoms was 59.7% (95% confidence interval (CI) 55.3 - 63.9). Independent of covariates, stavudine (d4T)-containing cART regimens and the fixed-dose combination of tenofovir (TDF) + emtricitabine (FTC) + efavirenz (EFV) were associated with more reports of multiple symptoms (adjusted odds ratio (aOR) 3.38; 95% CI 1.19 - 9.60 and aOR 2.67; 95% CI 1.21 - 5.88, respectively). Lopinavir/ritonavir (LPV/r)-containing regimens were associated with fewer reports of multiple symptoms (aOR 0.47; 95% CI 0.21 - 1.04). For EFV-based regimens, adolescents on d4T + lamivudine (3TC) + EFV were more likely to report multiple symptoms than those on TDF + FTC + EFV or those on abacavir (ABC) + 3TC + EFV (aOR 3.26; 95% CI 1.01 - 10.52, aOR 2.86; 95% CI 1.35 - 6.05 and aOR 1.08; 95% CI 0.64 - 1.82, respectively). However, only TDF + FTC + EFV cART was associated with lower levels of non-adherence among participants (aOR 0.44; 95% CI 0.21 - 0.93).Conclusions. Rates of multiple symptoms among HIV-positive ART-experienced adolescents were high. d4T-containing regimens and TDF + FTC + EFV were associated with more reports of multiple symptoms, whereas LPV/r-containing regimens were associated with fewer reports. However, adolescents on TDF + FTC + EFV were the most adherent subgroup. These findings support the World Health Organization-recommended discontinuation of d4T use, but also underscore the dilemma faced by clinicians when choosing between low-toxicity regimens and those that promote ART adherence, particularly among HIV-positive adolescents.Âhttp://www.samj.org.za/index.php/samj/article/download/12102/8274 |
| spellingShingle | H Natukunda L Cluver E Toska V Musiime A Yakubovich Beyond clinical trials: Crosssectional associations of combination antiretroviral therapy with reports of multiple symptoms and nonadherence among adolescents in South Africa South African Medical Journal |
| title | Beyond clinical trials: Crosssectional associations of combination antiretroviral therapy with reports of multiple symptoms and nonadherence among adolescents in South Africa |
| title_full | Beyond clinical trials: Crosssectional associations of combination antiretroviral therapy with reports of multiple symptoms and nonadherence among adolescents in South Africa |
| title_fullStr | Beyond clinical trials: Crosssectional associations of combination antiretroviral therapy with reports of multiple symptoms and nonadherence among adolescents in South Africa |
| title_full_unstemmed | Beyond clinical trials: Crosssectional associations of combination antiretroviral therapy with reports of multiple symptoms and nonadherence among adolescents in South Africa |
| title_short | Beyond clinical trials: Crosssectional associations of combination antiretroviral therapy with reports of multiple symptoms and nonadherence among adolescents in South Africa |
| title_sort | beyond clinical trials crosssectional associations of combination antiretroviral therapy with reports of multiple symptoms and nonadherence among adolescents in south africa |
| url | http://www.samj.org.za/index.php/samj/article/download/12102/8274 |
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