Determinants of Heterogeneous Adherence to HIV-Antiretroviral Therapies in the Multicenter AIDS Cohort Study

Abstract

Assessment of adherence to HIV antiretroviral therapy (ART) is required for studying therapeutic effectiveness and identifying subgroups needing focused education. The study's goals were to describe the level of ART adherence using self-reported recall over a 4-day period and to characterize determinants of lower adherence. The interaction between adherence and drug holidays on level of HIV RNA also was investigated. Perfect self-reported adherence was defined as taking all doses and numbers of pills as prescribed for current HIV medications. Independent predictors of<100% adherence were determined using multivariate logistic regression. Among 539 men, 419 (77.7%) were 100% adherent by the algorithm using self-reported data. HIV-1 RNA was <50 copies/ml in 48.2% of the adherent group versus 33.7% in the less adherent group (p = .015). This proportion dropped to 28% if a drug holiday was reported in addition to lower adherence. A drug holiday was not virologically detrimental if the participant was otherwise adherent. Determinants of lower adherence included African American race (odds ratio [OR], 2.4; p = .008), income <U.S.$50,000 (OR, 2.2; p = .002), no outpatient visits (OR, 3.6; p = .003) and increasing numbers of ART medications (OR, 4.5; p = .001). These data support the validity of using a questionnaire to assess adherence in observational studies. Identification of individuals with characteristics associated with lower adherence provides the basis for interventions to enhance adherence and optimize effective therapies.

Factors Associated with Suboptimal Antiretroviral Therapy Adherence to Dose, Schedule, and Dietary Instructions

“…While the low number of patients reporting suboptimal adherence to dose instructions was similar to rates reported in other studies (Cederfjä ll, 2002;Jensen-Fangel et al, 2002;Kleeberger et al, 2001;Molassiotis et al, 2002;Walsh, Horne, & Dalton, 2001), suboptimal adherence rates to schedule and dietary instructions were higher in our sample than those reported by Murphy et al (2004). Patients quite often express that their medication controls their lives and the difficulty of integrating medications into their daily activities as a major reason of suboptimal adherence (Ammassari et al, 2001;Chesney et al, 2000;Gifford et al, 2000).…”

“…Patients who receive a protease inhibitor (PI)-based medication regimen are more likely to report lower levels of adherence to dose than those receiving nonnucleoside reverse transcriptase inhibitors (NNRTI) regimens (Altice, Mostashari, & Friedland, 2001;Kleeberger et al, 2001;Mannheimer, Friedland, Matts, Child, & Chesney, 2002). Other studies have shown that adverse side effects are strongly associated with suboptimal adherence to dose instructions (Ammassari et al, 2001;Bartlett, 2002;Catz, Kelly, Bogart, Benotsch, & McAuliffe, 2000;Duran et al, 2001;Gao, Nau, Rosenbluth, Scott, & Woodward, 2000;Gifford et al, 2000;Molassiotis et al, 2002;Murphy, Marelich, Hoffman, & Steers, 2004).…”

“…Depressive symptoms (Catz et al, 2000;Chesney et al, 2000;Gordillo, del Amo, Soriano, & Gonzalez-Lahoz, 1999;Kleeberger et al, 2001;Murri et al, 2000;Paterson et al, 2000;Simoni, Frick, Lockhart, & Liebovitz, 2002), hopelessness (Sing et al, 1996), anxiety (Ingersoll, 2004;Molassiotis et al, 2002), HIV-related posttraumatic stress disorder symptoms (Delahanty, Bogart, & Figler, 2004) and lack of support (Altice et al, 2001;Catz et al, 2000;Duran et al, 2001;Gifford et al, 2000;Godin, Coté , Naccache, Lambert, & Trottier, 2005;Gordillo et al, 1999;Murphy et al, 2004;Murri et al, 2000;Simoni et al, 2002) have been shown to correlate to suboptimal adherence to dose instructions. Results are inconclusive as to the relationship between demographic variables such as gender, age, education level, and adherence to dose (Ammassari et al, 2002).…”

Cannabis use and HIV antiretroviral therapy adherence and HIV-related symptoms

“…Furthermore, a recall period of at least 7 days insures that a weekend, which is often associated with adherence difficulties, will be included (Simoni et al, 2006). Accordingly, two different recall periods were used for self-reported adherence (Kleeberger et al, 2001;Murphy et al, 2004). The total number of missed doses in the past 4 days and past 2 weeks, in conjunction with the total number of possible doses during the past 4 days and past 2 weeks, were used to yield both 4-day and 2-week percent self-reported adherence scores.…”

Latinos and HIV/AIDS: Examining Factors Related to Disparity and Identifying Opportunities for Psychosocial Intervention Research

“…A number of studies have supported the relationship between depressive symptoms and treatment nonadherence among heterogeneous samples of HIVpositive men (Catz et al 2000;Gonzalez et al 2004;Gordillo et al 1999;Hirschhorn et al 1998;Kleeberger et al 2001;Paterson et al 2000;Safren et al 2001;Simoni et al 2002). Symptoms of depression make the already difficult task of adhering to HIV treatment regimens much more difficult for patients.…”