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Plasma nevirapine concentrations predict virological and adherence failure in Kenyan HIV-1 infected patients with extensive antiretroviral treatment exposure
- Source :
- PLoS ONE, Vol 12, Iss 2, p e0172960 (2017), PLoS ONE
- Publication Year :
- 2017
- Publisher :
- Public Library of Science (PLoS), 2017.
-
Abstract
- Treatment failure is a key challenge in the management of HIV-1 infection. We conducted a mixed-model survey of plasma nevirapine (NVP) concentrations (cNVP) and viral load in order to examine associations with treatment and adherence outcomes among Kenyan patients on prolonged antiretroviral therapy (ART). Blood plasma was collected at 1, 4 and 24 hours post-ART dosing from 58 subjects receiving NVP-containing ART and used to determine cNVP and viral load (VL). Median duration of treatment was 42 (range, 12–156) months, and 25 (43.1%) of the patients had virologic failure (VF). cNVP was significantly lower for VF than non- VF at 1hr (mean, 2,111ng/ml vs. 3,432ng/ml, p = 0.003) and at 4hr (mean 1,625ng/ml vs. 3,999ng/ml, p = 0.001) but not at 24hr post-ART dosing. Up to 53.4%, 24.1% and 22.4% of the subjects had good, fair and poor adherence respectively. cNVP levels peaked and were > = 3μg.ml at 4 hours in a majority of patients with good adherence and those without VF. Using a threshold of 3μg/ml for optimal therapeutic nevirapine level, 74% (43/58), 65.5% (38/58) and 86% (50/58) of all patients had sub-therapeutic cNVP at 1, 4 and 24 hours respectively. cNVP at 4 hours was associated with adherence (p = 0.05) and virologic VF (p = 0.002) in a chi-square test. These mean cNVP levels differed significantly in non-parametric tests between adherence categories at 1hr (p = 0.005) and 4hrs (p = 0.01) and between ART regimen categories at 1hr (p = 0.004) and 4hrs (p
- Subjects :
- RNA viruses
Male
0301 basic medicine
Physiology
lcsh:Medicine
HIV Infections
Pathology and Laboratory Medicine
Chi Square Tests
Geographical Locations
Mathematical and Statistical Techniques
0302 clinical medicine
Immunodeficiency Viruses
Blood plasma
Medicine and Health Sciences
Public and Occupational Health
Treatment Failure
030212 general & internal medicine
Child
lcsh:Science
Multidisciplinary
Hematology
biology
Viral Load
Middle Aged
Vaccination and Immunization
Body Fluids
Blood
Medical Microbiology
Viral Pathogens
Viruses
Physical Sciences
Lentivirus
Female
Anatomy
Pathogens
Viral load
Statistics (Mathematics)
Research Article
medicine.drug
Adult
medicine.medical_specialty
Nevirapine
Adolescent
Anti-HIV Agents
Immunology
Antiretroviral Therapy
Research and Analysis Methods
Microbiology
Blood Plasma
Medication Adherence
Young Adult
03 medical and health sciences
Antiviral Therapy
Virology
Internal medicine
Retroviruses
Chi-square test
medicine
Highly-Active Antiretroviral Therapy
Humans
Dosing
Statistical Methods
Microbial Pathogens
Statistical Hypothesis Testing
Aged
business.industry
lcsh:R
Organisms
Biology and Life Sciences
HIV
biology.organism_classification
Kenya
030112 virology
Regimen
People and Places
Africa
HIV-1
lcsh:Q
Preventive Medicine
business
Viral Transmission and Infection
Mathematics
Subjects
Details
- Language :
- English
- ISSN :
- 19326203
- Volume :
- 12
- Issue :
- 2
- Database :
- OpenAIRE
- Journal :
- PLoS ONE
- Accession number :
- edsair.doi.dedup.....a90cc6167cc451fdf18547511b39a86b