Factors Associated With Incomplete Adherence to Dolutegravir-Based Antiretroviral Therapy in Southwestern Uganda.

BACKGROUND

Tenofovir/lamivudine/dolutegravir (TLD) is now the most prescribed antiretroviral therapy (ART) regimen worldwide. Although effective and well-tolerated, dolutegravir has been associated with weight gain and neuropsychiatric symptoms. The relationship between these adverse effects and adherence to TLD has not been well characterized.

METHODS

We conducted a secondary analysis of a prospective cohort study that followed 675 adults with HIV for 48 weeks in southwestern Uganda after they either transitioned to TLD from older ART regimens or newly initiated ART with TLD. At study weeks 0, 24, and 48, participants completed questionnaires assessing self-reported adherence, use of non-HIV medications, and symptoms. Clinical parameters related to HIV and opportunistic infections were obtained by chart review. Generalized estimating equation logistic regression models were fit to assess factors associated with incomplete adherence.

RESULTS

In total, 642 participants (95.1%; median age 44 years; 45.6% female) contributed data for at least two study visits. Incomplete adherence to TLD was rare overall, reported by 54 participants (8.4%) through 48 weeks. Incident headaches were associated with incomplete adherence (aOR 1.68; 95% CI: 1.03 to 2.76; P = 0.04), whereas previous ART experience (aOR 0.38; 95% CI: 0.21 to 0.70; P ≤ 0.01) and prescription of ≥1 non-HIV medication (aOR 0.48; 95% CI: 0.29 to 0.79; P ≤ 0.01) predicted better adherence. We found no relationship between perceived weight gain and incomplete adherence (aOR 0.39; 95% CI: 0.11 to 1.39; P = 0.15).

CONCLUSIONS

Incident headaches were associated with incomplete adherence to TLD in southwestern Uganda, whereas established pill-taking routines were associated with better adherence. Dolutegravir-associated weight gain did not affect adherence in this setting.