Similar Adherence Rates Favor Different Virologic Outcomes for Patients Treated with Nonnucleoside Analogues or Protease Inhibitors

Abstract

Patients receiving NNRTIs report a higher rate of adherence than do patients receiving PIs. Adherence is significantly influenced by the number of pills and daily doses received. Low adherence is a major determinant of virologic failure; however, different therapies have different cutoff values for adherence that determine a significant increment of risk.

Adherence to Antiretroviral Therapy in Managed Care Members in the United States: A Retrospective Claims Analysis

“…15 While recent studies suggest that a lower adherence threshold than 90% may be possible with the availability of more potent NNRTI or boosted PI regimens, [16][17][18] there are no definitive data. While the minimum adherence threshold needed is still being discussed, methods to improve patient adherence to ART to achieve a specific threshold have been well researched.…”

Issues in resistance, adherence, and comparative efficacy of the single-tablet regimen combination of tenofovir, emtricitabine, and efavirenz in the management of HIV-1 infection

“…82 Switching from two separate NRTIs to combination pills has also shown to improve adherence and patient satisfaction. 83,84 Additionally, patients on NNRTI-based regimens have been shown in the past to have better adherence than those on PI-based regimens, likely at least in part due to the relatively low pill count and simplicity of NNRTI combinations, 85 though this has never been confirmed in a randomized trial. The importance of decreased regimen complexity and pill burden may be most important in those with significant social barriers to care.…”

Evidence Based Health Benefits Management

“…Treatment failure has been shown to increase by 13% when patient adherence falls to 75%. 1 This drop-off in adherence also drives HIV drug resistance, which, in turn, further increases the total cost of managing this disease.…”

“…As shown in Figure 1, even relatively small declines of 25% in patient adherence to antiretroviral treatment increase the rate of treatment failure. 1 High but suboptimal levels of adherence can expose HIV to subinhibitory drug concentrations and thereby open the door to viral mutations and antiretroviral drug resistance. As a result, suboptimal patient adherence to treatment increases the economic burden of managing HIV/AIDS.…”