Beyond Virological Suppression: The Role of Adherence in the Late Haart Era

Ammassari, Adriana; Trotta, Maria Paola; Shalev, Noga; Marconi, Patrizia; Antinori, Andrea

doi:10.3851/imp2084

Cited by 35 publications

(27 citation statements)

References 57 publications

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“…However, HIV management also encompasses other considerations such as viral reservoirs, the effects of other inflammatory markers, and some evidence that suggests suboptimal adherence is associated with increased mortality. 18,19 Because of these reasons, in addition to the inherent complexity of medication adherence, the goalpost for ARV adherence should remain 100%.…”

Section: Discussionmentioning

confidence: 99%

Comparison of HIV Virologic Failure Rates Between Patients with Variable Adherence to Three Antiretroviral Regimen Types

Gordon

Gharibian

Chong

et al. 2015

AIDS Patient Care and STDs

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Medication adherence is a major determinant of antiretroviral (ARV) treatment success and a significant challenge for HIV-positive patients, yet a well-defined adherence threshold to maintain virologic suppression on current ARV regimens remains unclear. The present study evaluated 1915 Kaiser Permanente Southern California HIV-positive patients on one of three regimen types: (1) emtricitabine-tenofovir-efavirenz (FTC-TDF-EFV); (2) emtricitabine-tenofovir (FTC-TDF) and raltegravir (RAL); and (3) FTC-TDF and a boosted protease inhibitor, either darunavir (DRV) or atazanavir (ATV), to compare virologic failure rates between patients with varying levels of adherence to the regimens. Medication possession ratios (MPRs) were calculated to determine adherence, and HIV RNA PCR levels drawn 12-18 months after the initial pharmacy claim for the measured drug were used to determine virologic failure, which was defined as two consecutive HIV RNA PCR measurements ≥200 copies/mL. Adherence was inversely related to virologic failure, with an 80-90% MPR threshold resulting in no more than 3.5% virologic failure rate. In comparison, ≥90% MPR yielded no more that 1.1% virologic failure rate. Although the gold-standard adherence threshold for older ARV regimens has been 95%, an 80-90% MPR appears sufficient to maintain virologic suppression in patients treated with these three ARV regimen types.

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Section: Discussionmentioning

confidence: 99%

Comparison of HIV Virologic Failure Rates Between Patients with Variable Adherence to Three Antiretroviral Regimen Types

Gordon

Gharibian

Chong

et al. 2015

AIDS Patient Care and STDs

View full text Add to dashboard Cite

show abstract

“…The choice of adherence cutoff was based on previous studies and the expected adherence distribution. [30]…”

Section: Methodsmentioning

confidence: 99%

Adherence to extended postpartum antiretrovirals is associated with decreased breast milk HIV-1 transmission

Davis¹,

Miller²,

Hudgens³

et al. 2014

Aids

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Objective Estimate association between postpartum antiretroviral adherence and breastmilk HIV-1 transmission Design Prospective cohort study Methods Mother-infant pairs were randomized after delivery to immediately begin receiving 28 weeks of either triple maternal antiretrovirals (zidovudine, lamivudine, and either nevirapine, nelfinavir, or lopinavir-ritonavir) or daily infant nevirapine as part of the Breastfeeding, Antiretrovirals, and Nutrition study. Associations between postpartum antiretroviral adherence and rate of breastmilk HIV-1 transmission were estimated using Cox models. We measured adherence over four postpartum time intervals using pill count, suspension bottle weight, and maternal self-report. Adherence was categorized and lagged by one interval. Missing adherence measures were multiply imputed. Infant HIV-1 infection was determined by DNA PCR every 2-6 weeks. The primary endpoint was infant HIV-1 infection by 38 weeks of age among infants alive and uninfected at 5 weeks. Results Analyses included 1479 mother-infant pairs and 45 transmission events. Using pill count and bottle weight information, 22-40% of mother-infant pairs at any given interval were <90% adherent. Having ≥90% adherence was associated with a 52% (95% CI 3-76%) relative reduction in the rate of breastmilk HIV-1 transmission, compared with having <90% adherence when controlling for study arm, breastfeeding status, and maternal characteristics. Complete case analysis rendered similar results (n=501; relative reduction 59%, 95% CI 6-82%). Conclusion Non-adherence to extended postpartum ART regimens in ‘real world’ settings is likely to be higher than that seen in BAN. Identifying mothers with difficulty adhering to antiretrovirals, and developing effective adherence interventions, will help maximize benefits of ARV provision throughout breastfeeding.

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“…Of those who were non-adherent to their medication, 80% had experienced a relapse [29] care model was used and the study was conducted under routine outpatient circumstances. Other studies have shown that the medication compliance rate for non-psychiatric illness is 76%, while that for psychiatric illness is 58% [31].…”

Section: Discussionmentioning

confidence: 99%

“…Other structural barriers to maintaining engaged in care included distance from the clinic, confusion regarding their follow-up date, shame due to lack of follow-up, and conflict with work or school schedule. Interestingly, reasons cited for defaulting treatment in other studies of mentally ill patients have focused more on intolerance of side effects, relationship issues, and poor insight into their illness [30] [31].…”

Section: Discussionmentioning

confidence: 99%

Loss to Follow-Up among a Group of Patients with HIV and Severe Mental Illness in South Africa

Furin¹,

Gripshover²,

Jeenah³

et al. 2014

WJA

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Background: Persons with HIV and severe mental illness face numerous barriers in antiretroviral treatment adherence. More information is needed on reasons for loss of follow-up in this population. Methods: A retrospective analysis was conducted on adult HIV patients with a history of mental illness enrolled at an urban HIV clinic in Johannesburg, South Africa who discontinued care. Results: 24.8% of adult patients in the clinic discontinued follow-up during the study period. Of those discontinuing follow-up, 48 were successfully traced by home visits. Among this group, 21 (43.8%) were not engaged in care, 12 (25.0%) had transferred care, 9 (18.8%) were deceased, 3 (6.2%) had relocated, and 3 (6.2%) were missing. Transportation costs and distance, conflicts with work/school schedule, and confusion regarding when to return were the most frequently cited reasons for discontinuing follow-up. Conclusions: Although almost 25% of patients were lost to follow up, overall rates of retention in care for these patients were similar to those seen in other HIV-infected populations and higher than those seen among patients with psychiatric disease. Tracing patients through home visits proved to be an effective means to confirm the magnitude of patients lost to follow up, ascertain their outcomes, and elucidate the reasons for discontinuing care.

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Beyond Virological Suppression: The Role of Adherence in the Late Haart Era

Cited by 35 publications

References 57 publications

Comparison of HIV Virologic Failure Rates Between Patients with Variable Adherence to Three Antiretroviral Regimen Types

Comparison of HIV Virologic Failure Rates Between Patients with Variable Adherence to Three Antiretroviral Regimen Types

Adherence to extended postpartum antiretrovirals is associated with decreased breast milk HIV-1 transmission

Loss to Follow-Up among a Group of Patients with HIV and Severe Mental Illness in South Africa

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