Non-adherence to highly active antiretroviral therapy predicts progression to AIDS

Bangsberg, David R.; Perry, Sharon; Charlebois, Edwin D.; Clark, Richard A.; Roberston, M.; Zolopa, Andrew; Moss, Andrew R.

doi:10.1097/00002030-200106150-00015

Cited by 845 publications

(595 citation statements)

References 13 publications

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“…Selfreported antiretroviral therapy (ART) adherence in the previous 7 days was assessed using the visual analog scale (VAS). Non-adherence was defined as <95% adherence [38,39].…”

Section: Hiv-specific Measuresmentioning

confidence: 99%

Comprehensive and Medically Appropriate Food Support Is Associated with Improved HIV and Diabetes Health

et al. 2017

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Food insecurity is associated with negative chronic health outcomes, yet few studies have examined how providing medically appropriate food assistance to food-insecure individuals may improve health outcomes in resource-rich settings. We evaluated a communitybased food support intervention in the San Francisco Bay Area for people living with HIV and/or type 2 diabetes mellitus (T2DM) to determine the feasibility, acceptability, and potential impact of the intervention on nutritional, mental health, disease management, healthcare utilization, and physical health outcomes. The 6-month intervention provided meals and snacks designed to comprise 100% of daily energy requirements and meet nutritional guidelines for a healthy diet. We assessed paired outcomes at baseline and 6 months using validated measures. Paired t tests and McNemar exact tests were used with continuous and dichotomous outcomes, respectively, to compare pre-post changes. Fifty-two participants (out of 72 initiators) had both baseline and follow-up assessments, including 23 with HIV, 24 with T2DM, and 7 with both HIV and T2DM. Median food pick-up adherence was 93%. Comparing baseline to follow-up, very low food security decreased from 59.6% to 11.5% (p < 0.0001). Frequency of consumption of fats (p = 0.003) decreased, while frequency increased for fruits and vegetables (p = 0.011). Among people with diabetes, frequency of sugar consumption decreased (p = 0.006). We also observed decreased depressive symptoms (p = 0.028) and binge drinking (p = 0.008). At follow-up, fewer participants sacrificed food for healthcare (p = 0.007) or prescriptions (p = 0.046), or sacrificed healthcare for food (p = 0.029). Among people with HIV, 95% adherence to antiretroviral therapy increased from 47 to 70% (p = 0.046). Among people with T2DM, diabetes distress (p < 0.001), and perceived diabetes self-management (p = 0.007) improved. Comprehensive, medically appropriate food support is feasible and may improve multiple health outcomes for food-insecure individuals living with chronic health conditions. Future studies should formally test the impact of medically appropriate food support interventions for food-insecure populations through rigorous, randomized controlled designs.

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“…Selfreported antiretroviral therapy (ART) adherence in the previous 7 days was assessed using the visual analog scale (VAS). Non-adherence was defined as <95% adherence [38,39].…”

Section: Hiv-specific Measuresmentioning

confidence: 99%

Comprehensive and Medically Appropriate Food Support Is Associated with Improved HIV and Diabetes Health

et al. 2017

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“…Sufficiently high levels of adherence to ART are necessary to achieve and sustain viral suppression and to prevent disease progression and death [2], yet, many patients infected with human immunodeficiency virus (HIV)do not succeed in achieving or maintaining adequate levels of adherence to ART [3]. …”

Section: Introductionmentioning

confidence: 99%

Predictors and correlates of adherence to combination antiretroviral therapy (ART) for chronic HIV infection: a meta-analysis

Langebeek

Gisolf

Reiss

et al. 2014

BMC Med

359

132

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BackgroundAdherence to combination antiretroviral therapy (ART) is a key predictor of the success of human immunodeficiency virus (HIV) treatment, and is potentially amenable to intervention. Insight into predictors or correlates of non-adherence to ART may help guide targets for the development of adherence-enhancing interventions. Our objective was to review evidence on predictors/correlates of adherence to ART, and to aggregate findings into quantitative estimates of their impact on adherence.MethodsWe searched PubMed for original English-language papers, published between 1996 and June 2014, and the reference lists of all relevant articles found. Studies reporting on predictors/correlates of adherence of adults prescribed ART for chronic HIV infection were included without restriction to adherence assessment method, study design or geographical location. Two researchers independently extracted the data from the same papers. Random effects models with inverse variance weights were used to aggregate findings into pooled effects estimates with 95% confidence intervals. The standardized mean difference (SMD) was used as the common effect size. The impact of study design features (adherence assessment method, study design, and the United Nations Human Development Index (HDI) of the country in which the study was set) was investigated using categorical mixed effects meta-regression.ResultsIn total, 207 studies were included. The following predictors/correlates were most strongly associated with adherence: adherence self-efficacy (SMD = 0.603, P = 0.001), current substance use (SMD = -0.395, P = 0.001), concerns about ART (SMD = -0.388, P = 0.001), beliefs about the necessity/utility of ART (SMD = 0.357, P = 0.001), trust/satisfaction with the HIV care provider (SMD = 0.377, P = 0.001), depressive symptoms (SMD = -0.305, P = 0.001), stigma about HIV (SMD = -0.282, P = 0.001), and social support (SMD = 0.237, P = 0.001). Smaller but significant associations were observed for the following being prescribed a protease inhibitor-containing regimen (SMD = -0.196, P = 0.001), daily dosing frequency (SMD = -0.193, P = 0.001), financial constraints (SMD -0.187, P = 0.001) and pill burden (SMD = -0.124, P = 0.001). Higher trust/satisfaction with the HIV care provider, a lower daily dosing frequency, and fewer depressive symptoms were more strongly related with higher adherence in low and medium HDI countries than in high HDI countries.ConclusionsThese findings suggest that adherence-enhancing interventions should particularly target psychological factors such as self-efficacy and concerns/beliefs about the efficacy and safety of ART. Moreover, these findings suggest that simplification of regimens might have smaller but significant effects.Electronic supplementary materialThe online version of this article (doi:10.1186/s12916-014-0142-1) contains supplementary material, which is available to authorized users.

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“…Adherence to HAART has been associated with relative improvements in immunologic and virologic markers (Low-Beer et al, 2000;Paterson et al, 2001), increased body weight (Shikuma et al, 2004), and less rapid progression to Acquired Immunodeficiency Syndrome (AIDS; Bangsberg et al, 2001). Despite the seriousness of problems related to nonadherence, empirical studies on HAART adherence interventions for HIV-positive substance users are lacking (Simoni et al, 2005).…”

Section: Introductionmentioning

confidence: 99%

Voucher reinforcement improves medication adherence in HIV-positive methadone patients: A randomized trial

Sorensen

Haug

Delucchi

et al. 2007

Drug and Alcohol Dependence

145

136

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This clinical trial evaluated a contingency management intervention designed to improve medication adherence among HIV-positive methadone maintenance patients. After a 4-week baseline observation phase, eligible participants (N = 66) were randomly assigned to: (a) medication coaching sessions every other week to assist with adherence strategies (comparison group) or (b) medication coaching plus voucher reinforcement for opening electronic medication caps on time (voucher group). Baseline adherence (percent doses taken/percent total possible doses) was 51% using electronic measurement, 75% using self-report and 75% using pill count. The intervention was provided for 12 weeks, with a 4-week follow-up. The primary outcome results of the clinical trial indicated effectiveness during the intervention, with significant mean adherence differences between voucher and comparison groups using electronic measurement (78% vs. 56%), pill count (86% vs. 75%), and self-report (87% vs. 69%). Differences between groups faded after vouchers were discontinued. Contingency management shows promise as a strategy to promote antiretroviral medication adherence in this population.

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Non-adherence to highly active antiretroviral therapy predicts progression to AIDS

Cited by 845 publications

References 13 publications

Comprehensive and Medically Appropriate Food Support Is Associated with Improved HIV and Diabetes Health

Comprehensive and Medically Appropriate Food Support Is Associated with Improved HIV and Diabetes Health

Predictors and correlates of adherence to combination antiretroviral therapy (ART) for chronic HIV infection: a meta-analysis

Voucher reinforcement improves medication adherence in HIV-positive methadone patients: A randomized trial

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