Long-Term Adherence to First-Line Highly Active Antiretroviral Therapy in a Hospital-Based Cohort: Predictors and Impact on Virologic Response and Relapse

Abstract

A high level of adherence to highly active antiretroviral therapy (HAART) is essential to minimize the risk of treatment failure and HIV disease progression. This cohort study evaluated the prevalence and predictors of long-term adherence with first-line HAART in a hospital-based unselected sample of HIV patients from central Italy, and examined the association between adherence and virological response or relapse. Between July 1996 and June 2004, 171 patients (67.3% males; mean age, 41.2 years) were followed for at least 24 weeks and up to 8 years. Adherence was measured by patient self-reports and confirmed using pharmacy records. The prevalence of high-level adherence (>or=90%) at 6 months was 88.3%; slightly less than 80% at 12 months. The incidence of adherence failure in the sample remained fairly stable until 24 months of follow-up, then it declined about 5% every 6 months. Cox analysis showed that compared to single/separated patients, homeless and married persons were, respectively, 1.95 times more likely and two times less likely to experience adherence failure (p < 0.05). The adjusted risk of adherence failure among patients who did not suffer drug-related toxicity was 0.57 (p < 0.05). Medication adherence was significantly associated with shorter time to virological response and longer time to relapse. Adherents were 1.69 times more likely to achieve viral suppression and nine times less likely to experience relapse than nonadherents (p < 0.01). Efforts at improving adherence should be prolonged for at least 24 months. A protective role of marriage for adherence failure is promising but requires confirmation in further research, that should also clarify the exact mechanisms determining the association.

Adherence to Antiretroviral Therapy Among HIV-Infected Drug Users: A Meta-Analysis

“…Measuring long-term adherence is particularly challenging, since adherence often fluctuates (Carrieri et al 2003b) and may decrease over time (Howard et al 2002;Parruti et al 2006;Pearson et al 2007a, b;Pinheiro et al 2002). According to a study conducted by the HIV Epidemiology Research Study (HERS) with HIV-positive drug users, participants' adherence declined from 64% at 1 month to 45% at 6 months after initiation of HAART Avants et al (2001) Ratio of missed prescriptions decreased during methadone stabilization:…”

Factors Associated with Non-Adherence to Antiretroviral Therapy among Adults living with HIV/AIDS in Arsi Zone, Oromia

“…Understanding factors associated with poor adherence is essential to maximize virology suppression and reduce mortality [29]. Factors associated with non-adherence varies with gender [30].…”

HIV Care Providers' Implementation of Routine Alcohol Reduction Support for Their Patients

“…[5][6][7] In addition, studies have shown that the use of various substances can have an effect on HIV medication adherence. [8][9][10] While not all studies examining the relationship between alcohol use and medication adherence have found a negative association between the two, 11 some studies have determined that people consuming alcohol while undergoing ARV treatment prescribed are considerably less likely to be adherent to the medication. [12][13][14] Of especially great concern is the high prevalence of coinfection of HIV and hepatitis C virus (HCV), with the consequence that end-stage liver disease, accelerated as a result of alcohol use among those coinfected, has become a leading cause of illness and death among these individuals.…”