Measures of antiretroviral adherence for detecting viral non-suppression in people living with HIV

Hine, Paul; Smith, Rhodine; Eshun‐Wilson, Ingrid; Orrell, Catherine; Cohen, Karen; Leeflang, Mariska; Ford, Nathan

doi:10.1002/14651858.cd013080

Cited by 14 publications

(23 citation statements)

References 28 publications

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“…Another explanatory mechanism behind our findings could be that incomplete adherence identifies a subset of patients who develop intermittent viremia that is not captured between clinic visits [ 4 ], in particular given the antiviral potency and pharmacokinetic forgiveness of the new antiretrovirals and the current trends toward less frequent monitoring in clinical care [ 52 , 53 ]. This was particularly highlighted by the stronger association observed in PWH who missed ≥2 ART doses, suggesting that the clinical consequences of incomplete ART adherence could be accentuated in a subgroup of patients with sustained low adherence.…”

Section: Discussionmentioning

confidence: 99%

Association of Incomplete Adherence to Antiretroviral Therapy With Cardiovascular Events and Mortality in Virologically Suppressed Persons With HIV: The Swiss HIV Cohort Study

Castillo‐Mancilla

Cavassini

Schneider

et al. 2021

Open Forum Infectious Diseases

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Background Incomplete antiretroviral therapy (ART) adherence, even if sufficient to maintain viral suppression, is associated with enhanced inflammation in persons living with HIV (PLWH). However, its clinical implications remain unknown. Methods PLWH enrolled in the Swiss HIV Cohort Study without history of cardiovascular disease (CVD), who initiated ART between 2003-2018, and had viral suppression (<50 copies/mL) for ≥6 months, were evaluated. The association between incomplete self-reported ART adherence (≥1 or ≥2 missed doses in the last month) and (1) any CVD event (myocardial infarction, revascularization, cerebral hemorrhage, stroke, and/or death due to CVD event), or (2) non-CVD-related death was evaluated using adjusted Cox proportional hazards models. Results 6,971 PLWH (74% male) were included in the analysis; median (IQR) age was 39 (32,47) years. Median (IQR) follow-up was 8 (4,11) years, with 14 (8,23) adherence questionnaires collected per participant. In total, 205 (3%) participants experienced a CVD event and 186 (3%) non-CVD-related death. In an adjusted competing risk model where missing data were imputed, missing ≥1 ART doses showed an increased, but not statistically significant, risk in CVD events (HR: 1.23; 95% CI: 0.85-1.79; p=0.28). Non-CVD-related mortality showed a statistically significant increased risk with missing ≥1 ART doses (HR: 1.44; 1.00-2.07; p=0.05 and missing ≥2 ART doses (HR: 2.21; 1.37-3.57; p=0.001). Conclusions Incomplete ART adherence was significantly associated with an increased risk for non-CVD-related mortality in PLWH with virologic suppression. This highlights the potential role of non-adherence to ART as a driver of non-AIDS clinical outcomes.

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Section: Discussionmentioning

confidence: 99%

Association of Incomplete Adherence to Antiretroviral Therapy With Cardiovascular Events and Mortality in Virologically Suppressed Persons With HIV: The Swiss HIV Cohort Study

Castillo‐Mancilla

Cavassini

Schneider

et al. 2021

Open Forum Infectious Diseases

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“…Although the recommendations have improved the HIV outcomes among those on ART, adolescents still mainly present negative HIV outcomes compared to general population [24][25][26][27]. There is therefore a need to establish the barriers faced by adolescents with ART adherence despite the evidence-based guidelines as they have a negative baring on the 2010 to 2050 projections and the UNAIDS 2030 target.…”

Section: Introductionmentioning

confidence: 99%

Barriers to anti-retroviral therapy adherence among adolescents aged 10 to 19 years living with HIV in sub-Saharan Africa: A mixed-methods systematic review protocol

Hlophe

Tamuzi²,

Shumba³

et al. 2022

PLoS ONE

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Background Antiretroviral therapy (ART) adherence is fundamental in achieving viral load suppression and consequently attaining positive health outcomes among people living with HIV. However, ART adherence is sub-optimum among adolescents living with HIV (ALHIV) thus the high AIDS-related mortality even after World Health Organization (WHO) revised HIV treatment eligibility guidelines in 2010, 2013 and 2016. Consolidated trends of barriers to ART adherence among ALHIV aged 10 to 19 years in sub-Saharan countries post each eligibility guidelines revision to date are unknown. Methods and analysis We will conduct comprehensive search of peer-reviewed and grey literature databases publishing observational studies reporting data adherence and barriers to ART among ALHIV on ART. We will further search the reference lists of included studies and other relevant reviews. We will also do a citation search for included studies in the review. We will search in the following databases PubMed, Cochrane Review, Scopus on Excerpta Medica Database (Embase) and Cumulated Index to Nursing and Allied Health Literature (CINAHL). Furthermore WHO, Joint United Nations Programme on HIV/AIDS (UNAIDS) websites, conference proceedings and country reports will be searched to identify relevant literature. Data will be extracted from eligible studies and synthesis will be through categorizing studies by year of study, barriers, and outcomes. Meta-analysis and meta-synthesis will be conducted for quantitative and qualitative data, respectively. Where meta-synthesis is impossible, narrative synthesis will be conducted. We will only include studies conducted between 2010 and 2022 within sub-Saharan Africa countries. Discussion Adherence to ART at a high level is required to achieve adequate viral suppression and improve quality of life in ALHIV. The knowledge of barriers to ART among ALHV may aid in the design of interventions aimed at improving ART adherence. Trail registration Systematic review protocol registration: PROSPERO CRD42021284891.

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“…Because using the EDM device waned over time, with very few devices in use after 36 weeks, robust longitudinal modeling of EDM adherence and viral load outcomes was not possible. Other intervention research has found similar effects on adherence in the absence of viral load effects [ 14 , 46 – 50 ], although these were typically with self-reported adherence measures. Reasons for affecting EDM measured adherence but not viral load are not clear.…”

Section: Discussionmentioning

confidence: 81%

Randomized Controlled Trial of a Remote Coaching mHealth Adherence Intervention in Youth Living with HIV

et al. 2022

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Youth living with HIV (YLWH) in the US have low rates of viral suppression (VS). In a prospective randomized clinical trial (ATN152) that enrolled 89 YLWH on antiretroviral therapy (ART) with detectable viral load, we evaluated a 12 week triggered escalating real-time adherence (TERA) intervention with remote coaching, electronic dose monitoring (EDM), and outreach for missed/delayed doses compared to standard of care (SOC). Median [Q1, Q3] percent days with EDM opening was higher in TERA (72% (47%, 89%)) versus SOC (41% (21%, 59%); p < 0.001) and incidence of numbers of 7 day gaps between openings were lower (TERA to SOC ratio: 0.40; 95% CI 0.30, 0.53; p < 0.001). There were no differences in VS at week 12 (TERA 35%; 95% CI 21%, 51% versus SOC 36%; 95% CI 22%, 51%; p > 0.99) or later time-points. The intervention improved adherence but not VS in heavily ART-experienced YLWH. Remote coaching more closely tailored to the unique dosing patterns and duration of need for youth struggling to reach VS warrants further investigation.

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Measures of antiretroviral adherence for detecting viral non-suppression in people living with HIV

Cited by 14 publications

References 28 publications

Association of Incomplete Adherence to Antiretroviral Therapy With Cardiovascular Events and Mortality in Virologically Suppressed Persons With HIV: The Swiss HIV Cohort Study

Association of Incomplete Adherence to Antiretroviral Therapy With Cardiovascular Events and Mortality in Virologically Suppressed Persons With HIV: The Swiss HIV Cohort Study

Barriers to anti-retroviral therapy adherence among adolescents aged 10 to 19 years living with HIV in sub-Saharan Africa: A mixed-methods systematic review protocol

Randomized Controlled Trial of a Remote Coaching mHealth Adherence Intervention in Youth Living with HIV

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