Demographic, socio-economic, behavioral and clinical factors predicting virologic failure with generic fixed-dose combination antiretroviral therapy before universal health insurance coverage in northern Thailand

Southeast Asian J Trop Med Public Health. 2009 Jan;40(1):71-82.

Abstract

We conducted a 2-year prospective cohort study to investigate multiple aspects of factors predicting the outcome of fixed-dose combination antiretroviral (ARV) therapy with lamivudine, stavudine, and nevirapine (GPOvir) at a government referral hospital in northern Thailand. At 6 and 24 months after the initiation of GPOvir, viral load (VL) was measured to determine virologic failure (>400 RNA copies/ml) and demographic, socio-economic, behavioral and clinical data were collected. From 10 April 2002 to 31 January 2004, 409 patients participated in this study: 64/364 (17.0%) at 6 months and 55/345 (15%) at 24 months virologically failed treatment. On univariate analysis, besides ARV experience [odds ratio (OR), 3.08, 95% confidence interval (CI), 1.71 -5.57] and the frequency of delayed doses (OR, 2.97; 95% CI, 1.47-6.00), we identified one socioeconomic factor significantly associated with virologic failure: "not having child" (OR, 1.85; 95% CI, 1.03 - 3.34). Although the association with "not having child" became marginal on multivariate analysis, results of in-depth interviews and group discussions indicated that having a child was a strong motivating factor for good treatment compliance. We suggest that patients without children may need more attention. Further investigation of socio-economic factors is warranted.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Anti-HIV Agents / administration & dosage
  • Anti-HIV Agents / adverse effects
  • Anti-HIV Agents / therapeutic use*
  • CD4 Lymphocyte Count
  • Demography
  • Drug Therapy, Combination
  • Drugs, Generic / administration & dosage*
  • Drugs, Generic / adverse effects
  • Female
  • Forecasting
  • HIV Infections / drug therapy*
  • HIV Infections / immunology
  • HIV Infections / virology
  • HIV-1 / drug effects
  • Humans
  • Lamivudine / administration & dosage
  • Lamivudine / adverse effects
  • Lamivudine / therapeutic use*
  • Male
  • Middle Aged
  • Multivariate Analysis
  • Nevirapine / administration & dosage
  • Nevirapine / adverse effects
  • Nevirapine / therapeutic use*
  • Odds Ratio
  • Patient Compliance
  • Prospective Studies
  • Stavudine / administration & dosage
  • Stavudine / adverse effects
  • Stavudine / therapeutic use*
  • Thailand
  • Treatment Failure
  • Viral Load

Substances

  • Anti-HIV Agents
  • Drugs, Generic
  • Lamivudine
  • Nevirapine
  • Stavudine