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JAC Advance Access published online on May 10, 2006
Journal of Antimicrobial Chemotherapy, doi:10.1093/jac/dkl189
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© The Author 2006. Published by Oxford University Press on behalf of the British Society for Antimicrobial Chemotherapy. All rights reserved. For Permissions, please e-mail: journals.permissions@oxfordjournals.org
Received December 29, 2005
Revised April 10, 2006
Accepted April 18, 2006

Original article

Predictors of short-term success of antiretroviral therapy in HIV infection

Mark Oette 1 *, Arne Kroidl 1, Klaus Göbels 1, Antje Stabbert 1, Marion Menge 1, Abdurrahman Sagir 1, Dieter Kuschak 2, Tara O'Hanley 1, Johannes G. Bode 1, and Dieter Häussinger 1

1 Clinic for Gastroenterology, Hepatology, and Infectious Diseases, University Clinic Düsseldorf, Moorenstrasse 5, 40225 Düsseldorf, Germany
2 Medical Laboratories, Nordstrasse 44, 40477 Düsseldorf, Germany

* To whom correspondence should be addressed.
Mark Oette, E-mail: oettem{at}med.uni-duesseldorf.de


  Abstract

Objectives: The success of highly active antiretroviral therapy (HAART) in HIV infection may be influenced by numerous host factors. There is a lack of data presenting a combined assessment of a variety of these parameters for treatment efficacy in clinical routine practice.

Methods: Different indices of therapeutic drug monitoring (TDM) were evaluated prospectively in the context of self-reported adherence, health-related quality of life and social determinants, as measured by a questionnaire.

Results: A total of 210 individuals were studied between 2002 and 2004, 77% were males, mean age was 44 years, mean CD4 count was 336 cells/mm3 and 63% had a viral load <50 copies/mL. In univariate analysis, baseline viral load, unscheduled drug levels, a 4 h pharmacokinetic profile (PK-P) at a scheduled visit and self-reported complete adherence within the previous 2 weeks were significantly associated with virological success of HAART at 12 weeks. At 24 weeks, only baseline viral load, the 4 h PK-P and adherence were significantly associated with HAART efficacy. In multivariate analysis, baseline viral load, adherence, unscheduled drug levels, trough levels at a visit with appointment as well as the 4 h PK-P were significantly associated with virological success at 12 weeks. At 24 weeks, only adherence was significantly linked to outcome. The other parameters were not found to have an impact on treatment efficacy.

Conclusions: TDM and self-reported adherence were independently predictive of short-term HAART success in this prospective study. Unscheduled drug measurements provided similar diagnostic information as a 4 h PK-P. Thus, we propose the use of unscheduled drug level monitoring and self-reported adherence to help identify patients with elevated risk of virological failure.

Keywords: HAART; adherence; TDM; social; quality of life.
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