Medication persistence in the treatment of HIV infection: A review of the literature and implications for future clinical care and research

AIDS (London, England) (Impact Factor: 5.55). 01/2011; 25(3):279-90. DOI: 10.1097/QAD.0b013e328340feb0
Source: PubMed


Persistence, continuous treatment with a prescribed medication or intervention, is an important, but underrecognized aspect of medication treatment, especially for HIV. In contrast to adherence, which measures the percentage of patient behavior to a prescribed therapy, persistence measures the duration during which a patient remains on a prescribed therapy. Decreased persistence for HIV treatment, or shorter duration on therapy, is associated with increased rates of virological failure, development of antiretroviral resistance, and increased morbidity and mortality. Additionally, frequency and duration of nonpersistent episodes rather than adherence may be a better predictor of clinical outcomes in HIV-infected patients on certain regimens. In this review, we codify the constructs of persistence and adherence, and further define persistence as either patient or regimen persistence. Furthermore, current literature on the clinical consequences of and factors associated with suboptimal persistence is summarized. Finally, methods to measure persistence as well as interventions that may improve persistence and clinical outcomes are suggested.

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Available from: Frederick Altice, Nov 11, 2014
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    • "Emerging work on temporal patterns of drug detection suggests that a proportion of trial participants in these trials never had drug detected over any available assessment. Adherence refers to one's patterns of use for a regimen that he or she has adopted or engages with, and persistence refers to the length of time one engages with a regimen [24]. If some trial participants never started the regimen in the first place, then this would be more akin to notions of product uptake and adoption than product adherence or persistence. "
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    ABSTRACT: Despite considerable discussion and debate about adherence to preexposure prophylaxis (PrEP) for human immunodeficiency virus (HIV), scant data are available that characterize patterns of adherence to open-label PrEP. The current evidence base is instead dominated by research on adherence to placebo-controlled investigational drug by way of drug detection in active-arm participants of large randomized controlled trials (RCTs). Important differences between the context of blinded RCTs and open-label use suggest caution when generalizing from study product adherence to real-world PrEP use. Evidence specific to open-label PrEP adherence is presently sparse but will expand rapidly over the next few years as roll-out, demonstration projects, and more rigorous research collect and present findings. The current evidence bases established cannot yet predict uptake, adherence, or persistence with open-label effective PrEP. Emerging evidence suggests that some cohorts could execute better adherence in open-label use vs placebo-controlled research. Uptake of PrEP is presently slow in the United States; whether this changes as grassroots and community efforts increase awareness of PrEP as an effective HIV prevention option remains to be determined. As recommended by multiple guidelines for PrEP use, all current demonstration projects offer PrEP education and/or counseling. PrEP support approaches generally fall into community-based, technology, monitoring, and integrated sexual health promotion approaches. Developing and implementing research that moves beyond simple correlates of either study product use or open-label PrEP adherence toward more comprehensive models of sociobehavioral and socioecological adherence determinants would greatly accelerate progress. Intervention research is needed to identify effective models of support for open-label PrEP adherence.
    Clinical Infectious Diseases 07/2014; 59 Suppl 1(Suppl 1):S55-60. DOI:10.1093/cid/ciu266 · 8.89 Impact Factor
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    • "Consistent with previous studies (Bae et al., 2011; Carrico et al., 2011), participants who initiated ART and remained on it during all subsequent assessments that were completed over the 18-month investigation period were classified as engaging in ART persistence (1) and compared to those who didn't initiate or inconsistently utilized ART (0). "
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    ABSTRACT: Objective: Revised Stress and Coping Theory proposes that positive affect serves adaptive functions, and its beneficial effects are heightened during stressful periods. This study examined the prospective relationship between positive affect and engagement in care during the 18 months after a HIV seropositive diagnosis. Methods: The Coping, HIV, and Affect Interview (CHAI) cohort study enrolled 153 individuals who had recently received a HIV seropositive diagnosis. Using logistic and linear regression, baseline positive affect was examined as a predictor of linkage to HIV care, antiretroviral therapy (ART) persistence (i.e., starting ART and remaining on it during subsequent follow-up assessments), and mean log₁₀ HIV viral load over follow-up. Results: After controlling for education, T-helper (CD4+) count, HIV viral load, and negative affect, higher baseline positive affect independently predicted increased odds of linkage to HIV care at 3 months postdiagnosis (adjusted OR [AOR] = 1.10; 95% CI = 1.01-1.21) and ART persistence over the 18-month follow-up period (AOR = 1.08; 95% CI = 1.01-1.16). Positive affect was not directly associated with lower mean HIV viral load over follow-up. However, one standard deviation higher positive affect indirectly predicted 6.7% lower HIV viral load via greater odds of ART persistence (βindirect = -0.18, p < .05). Conclusions: Greater positive affect predicts linkage to HIV care and ART persistence. ART persistence, in turn, is associated with lower HIV viral load. Clinical research is needed to examine whether interventions designed to enhance positive affect can boost the effectiveness of HIV treatment as prevention.
    Health Psychology 11/2013; 33(7). DOI:10.1037/hea0000011 · 3.59 Impact Factor
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    • "Intimate partner violence (IPV) can be a major barrier to longitudinal HIV care, including persistence on antiretroviral therapy (ART) (Bae et al., 2011; Schafer et al., 2012). Poor retention in care along the HIV treatment cascade reduces the likelihood of ultimately achieving viral suppression and increases risk of ongoing HIV transmission (Cohen et al., 2011; Andrews et al., 2012; Gardner et al., 2011). "
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    ABSTRACT: Little is known about the association of intimate partner violence (IPV) with specific HIV treatment outcomes, especially among criminal justice (CJ) populations who are disproportionately affected by IPV, HIV, mental and substance use disorders (SUDs) and are at high risk of poor post-release continuity of care. Mixed methods were used to describe the prevalence, severity, and correlates of lifetime IPV exposure among HIV-infected jail detainees enrolled in a novel jail-release demonstration project in Connecticut. Additionally, the effect of IPV on HIV treatment outcomes and longitudinal healthcare utilization was examined. Structured baseline surveys defined 49% of 84 participants as having significant IPV-exposure, which was associated with female gender, longer duration since HIV diagnosis, suicidal ideation, having higher alcohol use severity, having experienced other forms of childhood and adulthood abuse, and homo/bisexual orientation. IPV was not directly correlated with HIV healthcare utilization or treatment outcomes. In-depth qualitative interviews with 20 surveyed participants, however, confirmed that IPV was associated with disengagement from HIV care especially in the context of overlapping vulnerabilities, including transitioning from CJ to community settings, having untreated mental disorders, and actively using drugs or alcohol at the time of incarceration. Post-release interventions for HIV-infected CJ populations should minimally integrate HIV secondary prevention with violence reduction and treatment for SUDs.
    International Journal of Prisoner Health 09/2013; 9(3):124-141. DOI:10.1108/IJPH-03-2013-0011
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