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: 3.23). 02/2007; 2(6):e552. DOI: 10.1371/journal.pone.0000552
Source: PubMed


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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Available from: Elin B Begley
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    • "ever history of incarceration by law enforcing agencies (p = 0.008), and having no home (p = 0.049) were significant predictors of loss to follow-up in the program at enrollment. There are many studies suggesting that adolescents and young adults are at a higher risk of non-adherence to HIV care and loss to follow-up19202122. Mobility may be high for younger PWIDs, they may have fewer sources of money for drugs or food, and they may not appreciate the value of drop-in center services (needle exchange, condoms, and health) as much as older PWIDs. "
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    • "Adherence to HIV medications. Of 47 studies addressing adherence to HIV medications (Applebaum et al., 2009; Arnsten et al., 2002; Berg et al., 2004; Beyene et al., 2009; Bonolo et al., 2005; Bouhnik et al., 2002; Campos et al., 2010; Chander et al., 2006; Chesney et al., 2000; Cohn et al., 2008; Cook et al., 2001; de Jong et al., 2005; Duran et al., 2001a, 2001b; Friedman et al., 2009; Golin et al., 2002; Halkitis et al., 2003, 2005; Heckman et al., 2004; Holmes et al., 2007; Howard et al., 2002; Ingersoll, 2004; Johnson et al., 2003; Lazo et al., 2007; Leserman et al., 2008; Liu et al., 2006; Martini et al., 2004; McDonnell Holstad et al., 2006; Mellins et al., 2009; Moatti et al., 2000; Mugavero et al., 2006; Murphy et al., 2004; Parsons et al., 2007; Peretti-Watel et al., 2006; Protopopescu et al., 2009; Rothlind et al., 2005; Roux et al., 2009; Safren et al., 2001; Samet et al., 2004; Silva et al., 2009; Spire et al., 2002; Sullivan et al., 2007; Theall et al., 2007; Waldrop-Valverde and Valverde, 2005; Waldrop-Valverde et al., 2006; Wang and Wu, 2007), 38 conducted multivariate analyses and, of these, 27 (71%) reported statistically signifi cant associations of poor adherence with alcohol consumption (range in reported effect sizes: 0.76–4.76). Among studies of specifi c patterns of alcohol use, signifi cantly poorer adherence (ORs) was reported by 9 of 12 studies of problem drinking (1.22–3.70); 2 of 3 studies of heavy episodic drinking (1.43–1.8), of which one found an effect only in women; 8 of 11 studies of moderate alcohol consumption (1.28–3.0); "
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    Full-text · Article · Nov 2012 · Journal of studies on alcohol and drugs
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