Adherence to Antiretrovirals Among US Women During and After Pregnancy

Department of Obstetrics, Gynecology and Women's Health, University of Medicine and Dentistry of New Jersey-New Jersey Medical School, Newark, NJ 07103-1709, USA.
JAIDS Journal of Acquired Immune Deficiency Syndromes (Impact Factor: 4.56). 08/2008; 48(4):408-17. DOI: 10.1097/QAI.0b013e31817bbe80
Source: PubMed


Antiretrovirals (ARVs) are recommended for maternal health and to reduce HIV-1 mother-to-child transmission, but suboptimal adherence can counteract its benefits.
To describe antepartum and postpartum adherence to ARV regimens and factors associated with adherence.
We assessed adherence rates among subjects enrolled in Pediatric AIDS Clinical Trials Group Protocol 1,025 from August 2002 to July 2005 on tablet formulations with at least one self-report adherence assessment. Perfectly adherent subjects reported no missed doses 4 days before their study visit. Generalized estimating equations were used to compare antepartum with postpartum adherence rates and to identify factors associated with perfect adherence.
Of 519 eligible subjects, 334/445 (75%) reported perfect adherence during pregnancy. This rate significantly decreased 6, 24, and 48 weeks postpartum [185/284 (65%), 76/118 (64%), and 42/64 (66%), respectively (P < 0.01)]. Pregnant subjects with perfect adherence had lower viral loads. The odds of perfect adherence were significantly higher for women who initiated ARVs during pregnancy (P < 0.01), did not have AIDS (P = 0.02), never missed prenatal vitamins (P < 0.01), never used marijuana (P = 0.05), or felt happy all or most of the time (P < 0.01).
Perfect adherence to ARVs was better antepartum, but overall rates were low. Interventions to improve adherence during pregnancy are needed.

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Available from: Susan E Cohn, Mar 14, 2014
    • "In previous research, a majority of mothers prioritized concerns about their infants' health and other socioeconomic issues over their own health (Butz et al., 1993; D'Auria, Christian, & Miles, 2006; Shannon et al., 2008). Mothers' adherence to maternal ARV regimens may decline by 30–56% during the postpartum period (Bardeguez et al., 2008; Mellins et al., 2008; Murphy et al., 2002). In this study, the mothers' adherence to ARV medications in pregnancy was reportedly 100% but declined to 60% during the testing period of their infants. "
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    • "There are some examples that suggest that integration of HIV services within general care may serve to enhance adherence. For example, Bardeguez et al. (2008) showed that the odds of perfect adherence were significantly higher for women who had initiated ARVs during pregnancy compared to those who were initiated post-partum. Malta et al. (2005) suggested that improving networking between services, establishing effective referral mechanisms, and increasing the integration of health workers could result in improved adherence. "
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    • "It is plausible that pregnancy may influence the timing of HAART initiation and therapeutic outcomes in HIV. Pregnancy may affect pharmacokinetics that could influence side effects.18–20 Pregnancy may contribute to greater drug intolerance in female recipients and higher rates of treatment discontinuation as following delivery HAART may be stopped depending on patient and physician preferences towards remaining on treatment (dependent on disease stage). "
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