Adherence and HIV RNA Suppression in the Current Era of Highly Active Antiretroviral Therapy

Abstract

Background We examined trends in adherence to highly active antiretroviral therapy (HAART) and HIV RNA suppression, and estimated the minimum cutoff of adherence to newer HAART formulations needed for HIV RNA suppression by regimen type. Methods We used VA pharmacy dispensing data from the Veterans Aging Cohort Study Virtual Cohort between October 2000 and September 2010, and defined adherence as the duration of time the patient had the medications available, relative to the total number of days between refills for all antiretrovirals in a year. Temporal trends in adherence and viral load suppression were examined by the patient's most frequently used HAART regimen in the year. The minimum needed adherence was defined as the level at which the odds of suppression was not significantly different than that observed with ≥95% adherence using repeated measures logistic regression. Results 21,865 HAART users contributed 82,217 person-years of follow-up. There was a significant increase (ptrend<0.001) in the proportion virally suppressed even among those with <95% adherence (2001: 38% to 2010: 84%) and the trend was similar when restricting to their first HAART regimen. For NNRTI multi-pill users, the odds of suppression did not differ for 85-89% adherence compared to those with ≥95% adherence, odds ratios: 0.82 (0.64,1.04), but for PI users, the odds of suppression significantly differed if adherence levels were <95% compared to ≥95% adherence. Conclusions Although all HIV-infected persons should be instructed to achieve perfect adherence, concerns of slightly lower adherence should not hinder prescribing new HAART regimens early in HIV infection.

Cognitive behavioral therapy for body image and self-care (CBT-BISC) in sexual minority men living with HIV: A randomized controlled trial.

“…Additionally, the raw difference in adherence change scores between conditions was 11.17% from baseline to 6 months for total adherence, and 16.00% from baseline to 6 months for on-time adherence. This highlights that the adherence improvement seen in CBT-BISC may constitute a clinically meaningful effect, as improvements in adherence of roughly 10% correspond to improvements in virologic suppression (Bangsberg, 2006; Liu et al, 2006; Viswanathan et al, 2015). …”

“…Although the benefits of ART adherence are clear, sustaining long-term adherence (e.g., 85% or higher; Viswanathan, Justice, Alexander et al, 2015) is often challenging. Meta-analytic findings found a mean level of ART adherence of 64% (Mills, Nachega, Buchan et al, 2006), with only 62% reaching a threshold of 90% adherence or greater (Ortego, Huedo-Medina, Llorca, et al, 2011).…”

Time trends in cancer incidence in persons living with HIV/AIDS in the antiretroviral therapy era

“…The strong inverse association between CD4 count and ADC risk is well-established, and evidence has accumulated in favor of a weaker, more subtle inverse association between CD4 count and risk for virus-NADC and possibly some non-virus-NADC [27, 44]. Thus, the decreasing ADC trends were probably driven by improvements in HIV care since the introduction of ART, including higher CD4 count at diagnosis [45], earlier post-diagnosis initiation of ART [46], improved ART regimens [47, 48], increased ART adherence [49], and increased virological suppression [49, 50]. These HIV care trends likely contributed to the decreasing NADC trends as well.…”

Relación entre la adherencia al tratamiento antirretroviral en pacientes VIH+ y el consumo de alcohol, asociado o no al uso de otras sustancias

“…Se consideraron pacientes adherentes aquellos que presentasen un 95% o más en la retirada de las tomas durante el último año según el Servicio de Farmacia Hospitalaria (Paterson et al, 2000). Se excluyeron del estudio aquellos pacientes cuya adherencia fuera igual o mayor que 90% pero menor de 95%, dado que no existe unanimidad en la literatura sobre los límites de esta diferenciación (Viswanathan et al, 2015). A todos los individuos participantes en el estudio se les aplicó una entrevista clínica semi-estructurada de evaluación elaborada ad hoc para el mismo.…”