Adherence to Antiretroviral Treatment and Correlation with Risk of Hospitalization among Commercially Insured HIV Patients in the United States

Abstract

PurposeA lower daily pill burden may improve adherence to antiretroviral treatment (ART) and clinical outcomes in patients with human immunodeficiency virus (HIV). This study assessed differences in adherence using the number of pills taken per day, and evaluated how adherence correlated with hospitalization.MethodologyCommercially insured patients in the LifeLink database with an HIV diagnosis (International Classification of Diseases, 9th Revision, Clinical Modification code 042.xx) between 6/1/2006 and 12/31/2008 and receipt of a complete ART regimen were selected for inclusion. Patients were grouped according to their daily pill count and remained on ART for at least 60 days. Outcomes included adherence and rates of hospitalization. Adherence was measured as the proportion of days between the start and end of the regimen in which the patient maintained supply of all initiated ART components. Logistic regressions assessed the relationship between pills per day, adherence, and hospitalization, controlling for demographics, comorbidities, and ART-naïve (vs. experienced) status.Results7,073 patients met the study inclusion criteria, and 33.4%, 5.8%, and 60.8% received an ART regimen comprising one, two, or three or more pills per day, respectively. Regression analysis showed patients receiving a single pill per day were significantly more likely to reach a 95% adherence threshold versus patients receiving three or more pills per day (odds ratio [OR] = 1.59; P<0.001). Regardless of the number of pills received per day, patients were over 40% less likely to have a hospitalization if they were adherent to therapy (OR = 0.57; P<0.001). Patients receiving a single pill per day were 24% less likely to have a hospitalization versus patients receiving three or more pills per day (OR = 0.76; P = 0.003).ConclusionsART consisting of a single pill per day was associated with significantly better adherence and lower risk of hospitalization in patients with HIV compared to patients receiving three or more pills per day.

Measurement of adherence to BCR-ABL inhibitor therapy in chronic myeloid leukemia: current situation and future challenges

“…As also observed in other chronic diseases, such as HIV infection, 68,69 regimen complexity seems to be another barrier to CML medication adherence as described by the recent cross-sectional study in the US and EU. 43 Difficulties related to treatment following BCR-ABL inhibitor therapy has been shown to be a significant factor affecting adherence, with dietary and dosing restrictions being associated with greater difficulty.…”

Adherence to Antiretroviral Therapy in Managed Care Members in the United States: A Retrospective Claims Analysis

“…1,21 STRs that reduce pill burden to as little as 1 pill taken once daily have been associated with improved adherence, reduced hospitalizations, and improved viral suppression. [22][23][24][25][26] In our study, patients who received STRs were about 1.3 times more likely to be adherent (i.e., MPR ≥ 90%) than patients receiving more than 1 (N = 3,528) antiretroviral product. Several studies showing an association with STR use and improved adherence involved the STR efavirenz/emtricitabline/tenofovir disoproxil fumarate (Atripla), [23][24][25][26] which is a recommended regimen for treatment-naïve patients per the HHS 2011 Guidelines.…”

“…1 One study concluded that patients on this fixed-dose STR reported a lower percentage of hospitalizations and emergency room visits. 24 Over 30% of all HIV-infected patients on antiretroviral therapy in the United States already use the STR efavirenz/emtricitabine/tenofovir disoproxil fumarate, and pharmaceutical sales experts predict that it will have the highest antiretroviral sales by 2013. 27 Since the end of the time frame in which we evaluated ART regimens (i.e., 2010), 2 additional STRs have been approved by the U.S. Food and Drug Administration: emtricitabine/rilpivirine/tenofovir disoproxil fumarate (Complera) in 2011 and elvitegravir/cobicistat/emtricitabine/tenofovir disoproxil fumarate (Stribild) in 2012.…”

“…One large U.S. MCO study found that treatment-experienced patients are at higher risk of nonadherence to ART than treatment-naïve patients. 24 Adherence was evaluated only for the index antiretroviral regimen and did not consider the impact of changing the antiretroviral regimen. Adherence may also be overstated for patients who switched to another ART regimen before finishing their current regimens.…”

Symptom severity, quality of sleep, and treatment adherence among patients suffering from schizophrenia and depression

“…For the group of patients with schizophrenia, a discriminant function analysis was performed with "Absolute Treatment Adherence" as a categorical dependent variable and the scores on the PANSS and PSQI as predictor variables. Furthermore, two multiple regression analyses [36] were conducted with one analysis containing "Degree of Treatment Adherence" as the dependent variable and the score on the BDI-II, as well as the score on the PSQI, as independent variables for the group of patients with depression. In the second analysis, "Degree of Treatment Adherence" was used as the dependent variable, and the score on the PANSS, as well as the score on the PSQI, were used as independent variables for the group of patients with schizophrenia.…”