High Prevalence of Clinical Jaundice Associated with Poor Adherence Among Adults on Boosted Atazanavir Antiretroviral Therapy Regimen at the Infectious Disease Institute HIV/AIDS Clinic in Kampala, Uganda

Background: Boosted atazanavir (ATV/r)-based Antiretroviral Therapy (ART) regimen is recommended by the World Health Organization (WHO) as second line treatment for HIV/AIDS. ATV/r is known to cause clinical jaundice, which may lead to non-adherence to treatment and the attendant treatment failure and drug resistance. We sought to determine the prevalence of clinical jaundice and explore its effect on adherence to the ART regimen. Methods: We conducted a cross-sectional study among 236 adult patients taking ATV/r-based ART regimens attending the Infectious Disease Institute (IDI) HIV/AIDS clinic in Kampala, Uganda from April to May 2019. We assessed the study participants by self-report for existing or previous experience of clinical jaundice after their start on ATV/r-based ART regimen. Adherence to the ATV/r-based ART was determined using the 8-item Morisky scale; score 3 was interpreted as good and poor adherence to ART, respectively. Logistic regression was used to explore the effect of clinical jaundice and other sociodemographic factors on adherence to ART regimen. Results: Of the 236 participants, majority were female (66.5%) with a mean age of 39.9 (SD 10.8) years and had been on ART for 10 to 13 years (42.8%). Most (69%) were on TDF/3TC backbone and 24% on AZT/3TC backbone. The period and point prevalence of clinical jaundice was 31.8% (95% confidence interval [CI]: 26.1% – 38.1%) and 21.1% (95% CI: 14.9% – 37.5%) respectively. Up to 8.5% (95% CI: 5.5 – 12.8) had poor adherence ( > 3). At multivariable analysis, clinical jaundice was the only predictor of poor adherence (adjusted odds ratio= 2.9, 95% CI: 1.15 – 7.34, p=0.024). Sex, alcohol use, and stigma and discrimination did not achieve statistical significance. Conclusion: Our study indicates a high prevalence of clinical jaundice among patients on ATV/r ART regimen and there is association between experiencing clinical jaundice and poor adherence. For patients whose ART adherence is affected by the presence of clinical jaundice; they should be switched to another second-line ART alternative.