Nonadherence to medical appointments is associated with increased plasma HIV RNA and decreased CD4 cell counts in a community-based HIV primary care clinic.
ABSTRACT This study examined the association of appointment nonadherence to markers of disease severity using one year of demographic and health information on 995 individuals with HIV in primary care at an urban community health centre. At the latest visit, 106 of 946 valid cases (11.2%) had a CD4 less than or equal to 200, and 454 of 936 valid cases (48.5%) had detectable plasma HIV RNA (greater than 50 copies/ml). Using logistic regression, appointment nonadherence (number of missed appointments) was a significant predictor (p < .03) of having an AIDS-defining CD4 count over and above the effects of number of kept appointments (p < .0001), and whether or not the patient was taking HAART (p < .002). Appointment nonadherence was also a significant predictor (p < .05) of having a detectable viral load over and above the effects of number of kept appointments (p < .003), HAART (p < .0001) and age (p < .004). Looking only at individuals with a detectable viral load at the earliest visit, the only significant unique predictor of improvement to an undetectable viral load at the latest visit was being on HAART (p < .05). Looking at those only with an undetectable viral load at the earliest visit, the only predictor of declining to a detectable viral load was number of kept appointments (p < 003), and being on HAART (p < .05).
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ABSTRACT: Abstract Poor adherence to antiretroviral therapies (ARTs) in human immunodeficiency virus (HIV)-infected patients increases the risk of incomplete viral suppression, development of viral resistance, progression to acquired immune deficiency syndrome and death. This study assesses the impact of specific treatment-related adverse events (AEs) on adherence to ART in the adult HIV patient population. A systematic review of studies involving adult HIV-infected patients aged ≥ 16 years that reported an odds ratio (OR) for factors affecting adherence to ART was conducted through a search of the EMBASE® and Medline® databases. Database searches were complemented with a search of titles in the bibliographies of review papers. Studies conducted in populations limited to a particular demographic characteristic or behavioural risk were excluded. To qualify for inclusion into a meta-analysis, treatment-related AEs had to be defined similarly across studies. Also, multiple ORs from the same study were included where study sub-groups were distinct. Random effects models were used to pool ORs. In total, 19 studies and 18 ART-related AEs were included in meta-analyses. Adherence to ART was significantly lower in patients with non-specific AEs than in patients who did not experience AEs [OR = 0.623; 95% confidence interval (CI): 0.465-0.834]. Patients with specific AEs such as fatigue (OR = 0.631; 95% CI: 0.433-0.918), confusion (OR = 0.349; 95% CI: 0.184-0.661), taste disturbances (OR = 0.485; 95% CI: 0.303-0.775) and nausea (OR = 0.574; 95% CI: 0.427-0.772) were significantly less likely to adhere to ART compared to patients without these AEs. Knowledge of specific treatment-related AEs may allow for targeted management of these events and a careful consideration of well-tolerated treatment regimens to improve ART adherence and clinical outcomes.AIDS Care 08/2012; 25(4). DOI:10.1080/09540121.2012.712667 · 1.60 Impact Factor
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ABSTRACT: Non-adherence to medical regimens is a critical threat to HIV-infected individuals. Persons living with HIV/AIDS must adhere to their outpatient medical appointments to benefit from continually improving HIV care regimens. The primary purpose of the present study was to identify individual and psychosocial characteristics associated with HIV-related medical appointment non-attendance. One hundred seventy eight adult participants attending the Outpatient Adult HIV/AIDS Immunology Clinic at Jackson Memorial Hospital (JMH) in Miami, Florida participated in the study. Scheduled and missed appointments obtained retrospectively over a 12-month period indicated that medical appointment non-attendance was a significant problem. Overall, 27.9% of scheduled appointments were missed during the study period. Young age and limited family support were predictors of non-attendance. These findings support those of others and highlight targeted intervention efforts to reduce appointment non-attendance among persons living with HIV/AIDS.AIDS Care 05/2011; 23(10):1219-25. DOI:10.1080/09540121.2011.555743 · 1.60 Impact Factor
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ABSTRACT: Adherence to treatment is currently of main concern for HIV/AIDS control, being associated with treatment success or failure. This systematic review highlights that adherence to treatment is a concept that traditionally refers only to antiretroviral medication intake and attendance at medical appointments. However, these aspects do not reflect the complexity of this topic. There is evidence about the relation between adherence to treatment and other factors that could facilitate or hinder its effectiveness but usually this evidence is not conclusive. In this review, an integral concept of adherence to treatment for HIV/AIDS infection is proposed, considering several simple and complex competences necessary to carry out the therapeutic regime. Additionally, factors with stronger empirical support associated with adherence are identified, including those related to the patient, the health system, the illness and the treatment, as well as social-interpersonal and cultural factors. The aim of this review is to propose new guidelines to evaluate adherence to treatment for HIV/AIDS infection and factors that are associated to it, in order to allow the design of more effective interventions.Acta Colombiana de Psicologia 12/2008; 11(2):101-113.