Patient and regimen characteristics associated with self-reported nonadherence to antiretroviral therapy.

Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America.
PLoS ONE (Impact Factor: 3.53). 02/2007; 2(6):e552. DOI: 10.1371/journal.pone.0000552
Source: PubMed

ABSTRACT Nonadherence to antiretroviral therapy (ARVT) is an important behavioral determinant of the success of ARVT. Nonadherence may lead to virological failure, and increases the risk of development of drug resistance. Understanding the prevalence of nonadherence and associated factors is important to inform secondary HIV prevention efforts.
We used data from a cross-sectional interview study of persons with HIV conducted in 18 U.S. states from 2000-2004. We calculated the proportion of nonadherent respondents (took <95% of prescribed doses in the past 48 hours), and the proportion of doses missed. We used multivariate logistic regression to describe factors associated with nonadherence. Nine hundred and fifty-eight (16%) of 5,887 respondents reported nonadherence. Nonadherence was significantly (p<0.05) associated with black race and Hispanic ethnicity; age <40 years; alcohol or crack use in the prior 12 months; being prescribed >or=4 medications; living in a shelter or on the street; and feeling "blue" >or=14 of the past 30 days. We found weaker associations with having both male-male sex and injection drug use risks for HIV acquisition; being prescribed ARVT for >or=21 months; and being prescribed a protease inhibitor (PI)-based regimen not boosted with ritonavir. The median proportion of doses missed was 50%. The most common reasons for missing doses were forgetting and side effects.
Self-reported recent nonadherence was high in our study. Our data support increased emphasis on adherence in clinical settings, and additional research on how providers and patients can overcome barriers to adherence.

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    ABSTRACT: A 52-year-old man with a history of homelessness, depression, and polysubstance use received a diagnosis of human immunodeficiency virus type 1 (HIV-1) infection in 2005 but has declined antiretroviral therapy (ART) in the past. His CD4+ T-cell count is now 257 per cubic millimeter, and his plasma HIV-1 RNA level is 17,000 copies per milliliter. The patient was prescribed a multipill antiretroviral regimen 2 months ago but has not followed this regimen regularly because "taking out lots of pills in the shelter just announces to the world that I have AIDS [the acquired immunodeficiency syndrome]." The patient desires to keep his HIV status private and states that he would take medications regularly if he could take just "one pill once a day." The patient is not taking any other medications; his renal function is normal. How should he be evaluated and treated?
    New England Journal of Medicine 07/2014; 371(3):248-59. DOI:10.1056/NEJMct1215532 · 54.42 Impact Factor
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    ABSTRACT: Background Adherence 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.Methods We 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.Conclusions These 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.
    BMC Medicine 08/2014; 12(1):142. DOI:10.1186/PREACCEPT-1453408941291432 · 7.28 Impact Factor
  • 05/2014; 1(2). DOI:10.1007/s40615-014-0012-8

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