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Honghu Liu,
Ira B Wilson,
Kathy Goggin, Nancy Reynolds,
Jane M Simoni,
Carol E Golin,
Marc I Rosen,
Robert Gross,
Glenn Wagner,
Robert H Remien,
Neil Schneiderman,
Judith A Erlen,
Julia H Arnsten,
David R Bangsberg
[show abstract]
[hide abstract]
ABSTRACT: The integration of original data from multiple antiretroviral (ARV) adherence studies offers a promising, but little used method to generate evidence to advance the field. This paper provides an overview of the design and implementation of MACH14, a collaborative, multi-site study in which a large data system has been created for integrated analyses by pooling original data from 16 longitudinal ARV adherence studies. Studies selected met specific criteria including similar research design and data domains such as adherence measured with medication event monitoring system, psychosocial factors related to adherence behavior, and virologic and clinical outcomes. The data system created contains individual data (collected between 1997 and 2009) from 2,860 HIV patients. Collaboration helped resolve the challenges inherent in pooling data across multiple studies, yet produced a data system with strong statistical power and potentially greater capacity to address key scientific questions than possible with single-sample studies or even meta-analytic designs.
AIDS and Behavior 08/2012; · 3.49 Impact Factor
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Becky L Genberg,
Ira B Wilson,
David R Bangsberg,
Julia Arnsten,
Kathy Goggin,
Robert H Remien,
Jane Simoni,
Robert Gross, Nancy Reynolds,
Marc Rosen,
Honghu Liu
[show abstract]
[hide abstract]
ABSTRACT: Adherence to antiretroviral therapies (ART) is the strongest predictor of viral suppression among individuals infected with HIV, however, limited data exists to understand the patterns of adherence that confer the greatest benefit across different ART regimens.
Longitudinal data pooled from 16 studies conducted between 1997 and 2009 across the United States.
Adherence was measured using Medication Event Monitoring System. Percentage of time with sufficient drug concentrations (covered time) and the length of the longest treatment interruption during the 28 days prior to plasma HIV-RNA measurements were calculated. Logistic regression with generalized estimating equations was used to estimate medication-specific adherence estimates on detectable HIV-RNA (>400 copies/ml).
One thousand and eighty-eight participants with 3795 HIV-RNA measures were studied. Both lower covered time and greater longest interruption showed dose-response relationships with the odds of detectable HIV-RNA; however, estimates did not vary by medication regimen. Compared with 93-100% coverage, periods of 0-25% covered time had a three-fold increased risk of detectable HIV-RNA [odds ratio (OR) = 3.22, 95% confidence interval (CI): 2.48-4.19]. Similarly, compared to longest interruptions of 0-48 h, longest interruptions of 21-28 days had a nearly four-fold increased risk of detectable HIV-RNA (OR = 3.65, 95% CI: 2.77, 4.81).
We found that adherence was consistently strongly associated with treatment response across ART regimens. Of the patterns of adherence, longer interruptions may have greater impact than covered time. Future research should investigate additional methods for examining adherence patterns, understanding the determinants of consecutive missed doses and the evaluation of interventions designed to address interruptions in treatment.
AIDS (London, England) 07/2012; 26(11):1415-23. · 4.91 Impact Factor
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Becky L Genberg,
Ira B Wilson,
David Bangsberg,
Julia Arnsten,
Kathy Goggin,
Robert H Remien,
Jane Simoni,
Robert Gross, Nancy Reynolds,
Marc Rosen,
Honghu Liu
[show abstract]
[hide abstract]
ABSTRACT: OBJECTIVE:: Adherence to antiretroviral therapies (ART) is the strongest predictor of viral suppression among individuals infected with HIV, however limited data exists to understand the patterns of adherence that confer the greatest benefit across different ART regimens. DESIGN:: Longitudinal data pooled from 16 studies conducted between 1997 and 2009 across the United States. METHODS:: Adherence was measured using Medication Event Monitoring System (MEMS). Percent of time with sufficient drug concentrations (covered time) and the length of the longest treatment interruption during the 28 days prior to plasma HIV-RNA measurements were calculated. Logistic regression with generalized estimating equations (GEE) was used to estimate medication-specific adherence estimates on detectable HIV-RNA (>400 copies/mL). RESULTS:: 1,088 participants with 3,795 HIV-RNA measures were studied. Both lower covered time and greater longest interruption showed dose response-relationships with the odds of detectable HIV-RNA, however estimates did not vary by medication regimen. Compared with 93-100% coverage, periods of 0-25% covered time had a three-fold increased risk of detectable HIV-RNA (OR=3.22, 95% CI: 2.48, 4.19). Similarly, compared to longest interruptions of 0-48 hours, longest interruptions of 21-28 days had a nearly four-fold increased risk of detectable HIV-RNA (OR = 3.65, 95% CI: 2.77, 4.81). CONCLUSIONS:: We found that adherence was consistently strongly associated with treatment response across ART regimens. Of the patterns of adherence, longer interruptions may have greater impact than covered time. Future research should investigate additional methods for examining adherence patterns, understanding the determinants of consecutive missed doses, and the evaluation of interventions designed to address interruptions in treatment.
AIDS (London, England) 04/2012; · 4.91 Impact Factor
