Poor quality of life and incomplete self-reported adherence predict second-line ART virological failure in resource-limited settings

AIDS Care, January 2021.

Lower health-related quality of life and lower adherence have been found to be independent predictors of virologic failure among people starting ART in U.S. clinical trials. A5273 evaluated whether quality of life and self-reported adherence could predict early second-line antiretroviral virological failure in less resource-rich countries.

A5273 evaluated two second-line ART regimens among individuals from 15 sites in nine low-middle income countries: Brazil, India, Kenya, Malawi, Peru, South Africa, Tanzania, Thailand, and Zimbabwe. The study defined early virological failure as confirmed HIV-1 RNA viral load higher than 400 copies/mL after 24 weeks of second-line ART. Participants completed the quality of life questionnaire (ACTG SF-21), which has eight domains: General Health Perceptions, Physical Functioning, Role Functioning, Social Functioning, Cognitive Functioning, Pain, Mental Health, and Energy/Fatigue.

Of 500 individuals (51% women, median age 39 years) included in this study, 79% and 75% self-reported complete adherence (no missing doses in the past month) at 4 and 24 weeks after starting second-line ART, respectively. Early virological failure was experienced by 7% and was more common among those who self-reported incomplete adherence. Participants with low quality of life had higher rates of early virological failure.

A5273 verified that lower quality of life adds to self-reported incomplete adherence in predicting early virological failure. These findings indicate that quality of life and adherence assessments after second-line ART initiation could be implemented as real-time measurements to identify individuals at higher risk of subsequent virological failure in low-middle income countries. These individuals may benefit from interventions to improve quality of life, such as social self-value empowerment and yoga, or to optimize adherence, such as text-message reminders.

Bottom line: No matter where you live or how you feel about yourself, your quality of life influences your success or failure in taking medicines to treat HIV.

Torres, T. S., Harrison, L. J., La Rosa, A. M., Zheng, L., Cardoso, S. W., Ulaya, G., Akoojee, N., Kadam, D., Collier, A. C., Hughes, M. D., & for AIDS Clinical Trials Group (ACTG) A5273 Study Group (2021). Poor quality of life and incomplete self-reported adherence predict second-line ART virological failure in resource-limited settingsAIDS care, 1–10. Advance online publication. https://doi.org/10.1080/09540121.2021.1874275