The phenomenon of missing doses in a cohort of HIV patients with good adherence to highly active antiretroviral therapy

Lee, S S; Ma, Kurtland; Chu, E K Y; Wong, Ka-Hing

doi:10.1258/095646207780132497

Cited by 5 publications

(2 citation statements)

References 11 publications

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“…For the 36 studies included here, there were no disagreements between the first reviewer (LL) and the second reviewer (ZM). Fig 1 shows the flowchart for selecting articles [ 6 – 41 ].…”

Section: Methodsmentioning

confidence: 99%

Comparisons of Adherence to Antiretroviral Therapy in a High- Risk Population in China: A Systematic Review and Meta-Analysis

Zhou¹,

Wang²,

Lü³

et al. 2016

PLoS ONE

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BackgroundReports on antiretroviral therapy (ART) adherence are scare in China; we performed this meta-analysis to estimate ART adherence rates in different populations at high risk for HIV transmission in China.MethodsWe searched PubMed, Chinese Biomedical Literature Database (Chinese), China National Knowledge Infrastructure (Chinese), and Wanfang (Chinese) to identify studies published from January 1985 to May 2015. We used random-effects meta-analysis to calculate weighted mean estimates across studies and 95% CIs. Data were pooled with proportions transformed prior to pooling using the Freeman–Tukey double arcsine transformation and then back transformed to the original scale. We calculated the I2 (and its 95% confidence intervals) and tau2 to assess between-study heterogeneity.ResultsWe identified 36 eligible articles, including 6885 HIV-positive individuals, reporting ART adherence. Pooled analysis produced an estimate of 77.61% (95% CI = 71.63–83.08) of patients with HIV with adequate adherence; however, high heterogeneity was observed between studies (I2 = 96.60%, 95%CI = 96.00%-97.20%; tau2 = 0.16). Three studies, which included 149 old HIV-infected patients, reported the highest ART adequate adherence rate (89.39%, 95% CI = 72.01–99.26) with high heterogeneity between the studies (I2 = 86.20%, 95%CI = 60.00–95.20%; tau2 = 0.13). While, only two studies, which included 143 heterosexual transmission group (HTG) patients, reported the lowest ART adequate adherence rate (51.55%, 95% CI = 41.33–61.71) with low heterogeneity between the studies (I2 = 31.3%, tau2 = 0.007). In the multivariable meta-regression model, high-risk populations was the main factor explaining heterogeneity (variance explained 28.14%).ConclusionsART adherence in some high-risk populations (e.g., heterosexual transmission group) is below the recommended levels for maintaining virologic suppression. It is crucial to develop comprehensive intervention strategies to promote ART adherence in high-risk populations and effectively prevent the spread of HIV/AIDS in China.

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“…For the 36 studies included here, there were no disagreements between the first reviewer (LL) and the second reviewer (ZM). Fig 1 shows the flowchart for selecting articles [ 6 – 41 ].…”

Section: Methodsmentioning

confidence: 99%

Comparisons of Adherence to Antiretroviral Therapy in a High- Risk Population in China: A Systematic Review and Meta-Analysis

Zhou¹,

Wang²,

Lü³

et al. 2016

PLoS ONE

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“…Nonadherence is a dynamic process; it varies over time, and may be expressed in different forms, such as a ‘missed dose phenomenon’ [11,12] or the interruption of therapy. Many studies on adherence in HIV‐infected patients have focused on quantitative and global measures, and only a few studies have reported data beyond 3 years of follow‐up [13–15].…”

Section: Introductionmentioning

confidence: 99%

Impact of different patterns of nonadherence on the outcome of highly active antiretroviral therapy in patients with long‐term follow‐up

Knobel¹,

Urbina

González³

et al. 2009

HIV Medicine

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ObjectivesThe aim of the study was to evaluate the impact of different patterns of nonadherence on treatment outcomes in patients with long-term follow-up. MethodsThis cohort study included patients who began highly active antiretroviral therapy during 1996-1999, with the last follow-up in 2007. Adherence was evaluated every 2 months by monitoring of pharmacy refills and by using self-reports. Patients were considered nonadherent at a specific visit when less than 90% of the prescribed drugs had been taken. Adherence was categorized as follows. (A) Continuous adherence: a patient had to be adherent in all of the evaluations throughout the period of follow-up. (B) Treatment interruption: drugs were not taken for more than 3 days, for any reason. Treatment failure was defined as viral load 4500 HIV-1 RNA copies/mL or death. Cox proportional risk models were used to calculate adjusted relative hazards (ARHs) of treatment failure. ResultsA total of 540 patients were included in the study, with a median follow-up of 8.3 years. Only 32.78% of patients achieved and maintained continuous adherence, and 42.78% of patients had treatment interruptions. Noncontinuous adherence [ARH 1.48; 95% confidence interval (CI) 1.02-2.14] and treatment interruptions (ARH 1.39; 95% CI 1.04-1.85) were associated with treatment failure for the overall cohort; however, for patients with more than 3 years of follow-up, only treatment interruptions were independently associated with treatment failure. ConclusionsOnly one-third of patients managed to achieve continuous adherence, and almost half of the patients had treatment interruptions, which have a particularly marked effect on treatment outcomes over the long term. IntroductionThe goals of HIV infection treatment are to suppress viraemia, to improve immune function and to delay disease progression over the long term [1,2]. Different factors affect the effectiveness of antiretroviral therapy (ART), such as the level of plasma HIV RNA, the degree of immunodeficiency and drug resistance; however, nonadherence may be the most important challenge to achieving the goals of ART.Previous studies have emphasized the effect of adherence on virological, immunological and survival endpoints [3][4][5][6][7][8].A high level of adherence to combined ART is essential to minimize the risk of treatment failure. However, the level of adherence necessary to obtain and maintain virological suppression may vary according to the type of ART [9,10].Nonadherence is a dynamic process; it varies over time, and may be expressed in different forms, such as a 'missed dose phenomenon ' [11,12] focused on quantitative and global measures, and only a few studies have reported data beyond 3 years of follow-up [13][14][15]. The aim of this study was to evaluate the impact of different patterns of nonadherence (missed doses and treatment interruptions) on the risk of treatment failure in HIV-infected patients with long-term follow-up. Patients and methodsThis cohort study analysed data of HIV-infected patients older tha...

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Adherence to Highly Active Antiretroviral Therapy (HAART): A Meta-Analysis

et al. 2011

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This meta-analysis synthesizes eighty-four observational studies, conducted across twenty countries, to determine the mean proportion of people who reported ≥90% adherence to prescribed highly active antiretroviral therapy (HAART) and to identify the factors associated with high levels of adherence. Eight electronic databases were searched to locate all relevant studies available by January 2010, which were then coded for sample characteristics and adherence levels. The average rate of reporting ≥90% adherent HAART adherence is 62%. However, this proportion varies greatly across studies. In particular, a greater proportion of individuals maintaining ≥90% adherence to HAART is more likely in studies with higher proportions of men who have sex with men (MSM) and lower proportions of injection drug users (IDU), with participants in an earlier stage of infection, and in studies conducted in countries characterized by lower Human Development Index (HDI) scores.

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The phenomenon of missing doses in a cohort of HIV patients with good adherence to highly active antiretroviral therapy

Cited by 5 publications

References 11 publications

Comparisons of Adherence to Antiretroviral Therapy in a High- Risk Population in China: A Systematic Review and Meta-Analysis

Comparisons of Adherence to Antiretroviral Therapy in a High- Risk Population in China: A Systematic Review and Meta-Analysis

Impact of different patterns of nonadherence on the outcome of highly active antiretroviral therapy in patients with long‐term follow‐up

Adherence to Highly Active Antiretroviral Therapy (HAART): A Meta-Analysis

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