{"doi":"10.1093/cid/ciac232","title":"Adherence Measured Using Electronic Dose Monitoring is Associated with Emergent Antiretroviral Resistance and Poor Outcomes in People with Human Immunodeficiency Virus/AIDS and Multidrug-Resistant Tuberculosis","abstract":"BACKGROUND: Medication adherence is known to challenge treatment of human immunodeficiency virus (HIV)/AIDS and multidrug-resistant tuberculosis (MDR-TB). We hypothesized that adherence using electronic dose monitoring (EDM) would identify an antiretroviral therapy (ART) adherence threshold for emergent ART resistance and predict treatment outcomes in patients with MDR-TB and HIV on ART and bedaquiline-containing TB regimens. METHODS: A prospective cohort of adults with MDR-TB and HIV on ART and initiating MDR-TB treatment with bedaquiline were enrolled at a public hospital in KwaZulu-Natal, South Africa (PRAXIS Study). Participants received separate EDM devices that measure adherence to bedaquiline and ART (nevirapine or lopinavir/ritonavir). Adherence was calculated cumulatively over 6 months. Participants were followed through completion of MDR-TB treatment. HIV genome sequencing was performed at baseline and 2 and 6 months on samples with HIV RNA ≥1000 copies/mL. RESULTS: From November 2016 through February 2018, 198 persons with MDR-TB and HIV were enrolled and followed (median, 17.2 months; interquartile range, 12.2-19.6). Eleven percent had baseline ART resistance mutations, and 7.5% developed emergent ART resistance at 6 months. ART adherence was independently associated with ART resistance and mortality. Modeling identified a significant (P < .001), linear association between ART adherence and emergent resistance, suggesting a strong association without a specific threshold. CONCLUSIONS: Our findings highlight the need for ART resistance testing, especially in patients with MDR-TB and HIV, which is currently not the standard of care in resource-limited settings. Despite short follow-up duration, reduced ART adherence was significantly associated with emergent resistance and increased mortality. CLINICAL TRIALS REGISTRATION: NCT03162107.","journal":"Clinical Infectious Diseases","year":2022,"id":253280,"datarank":0.7428649466878017,"base_score":3.1354942159291497,"endowment":3.1354942159291497,"self_citation_contribution":0.47032413238937254,"citation_network_contribution":0.2725408142984292,"self_endowment_contribution":0.47032413238937254,"citer_contribution":0.2725408142984292,"corpus_percentile":null,"corpus_rank":null,"citation_count":22,"citer_count":10,"citers_with_citation_signal":6,"citers_with_endowment":6,"datacite_reuse_total":0,"is_dataset":false,"is_dataset_confidence":0.9642,"is_data_producer":true,"deposit_databanks":{"ClinicalTrials.gov":["NCT03162107"]},"is_oa":true,"file_count":0,"downloads":0,"has_version_chain":false,"published_date":"2022-01-01","fair_score":null,"fair_percentile":null,"algorithm_id":"datarank_citation_only_1hop_v6","ranking_scope":"data_only","authors":[{"id":276507,"name":"Allison Wolf","orcid":null,"position":1,"is_corresponding":false},{"id":282138,"name":"Benjamin Chimukangara","orcid":"0000-0002-8391-4531","position":2,"is_corresponding":false},{"id":327409,"name":"James C. M. Brust","orcid":null,"position":3,"is_corresponding":false},{"id":69666,"name":"Richard Lessells","orcid":"0000-0003-0926-710X","position":4,"is_corresponding":false},{"id":305152,"name":"K. Rivet Amico","orcid":"0000-0002-4458-6934","position":5,"is_corresponding":false},{"id":487634,"name":"Resha Boodhram","orcid":null,"position":6,"is_corresponding":false},{"id":210645,"name":"Nalini Singh","orcid":null,"position":7,"is_corresponding":false},{"id":371103,"name":"Catherine Orrell","orcid":"0000-0003-1134-7475","position":8,"is_corresponding":false},{"id":462060,"name":"Gerald Friedland","orcid":"0000-0002-9400-6539","position":9,"is_corresponding":false},{"id":252303,"name":"Kogieleum Naidoo","orcid":"0000-0002-8874-6661","position":10,"is_corresponding":false},{"id":252304,"name":"Nesri Padayatchi","orcid":"0000-0003-2543-9071","position":11,"is_corresponding":false},{"id":104638,"name":"Max R. O’Donnell","orcid":"0000-0002-1232-3718","position":12,"is_corresponding":false},{"id":899231,"name":"Mark Bateman","orcid":null,"position":0,"is_corresponding":true}],"reference_count":32,"raw_metadata":null,"created_at":"2026-07-19T00:24:55.325369Z","pmid":"35352097","pmcid":null,"fwci":null,"citation_percentile":null,"influential_citations":0,"oa_status":null,"license":null,"views":0,"total_file_size_bytes":0,"version_count":0,"fair_f":null,"fair_a":null,"fair_i":null,"fair_r":null,"fair_zscore":null,"fair_rationale":null,"fair_model":null,"fair_agent_version":null,"fair_fulltext_source":null,"fair_has_llm":null,"fair_computed_at":null,"clinical_trials":[],"software_tools":[],"db_accessions":[],"linked_datasets":[],"topics":[]}