Adherence to antiretroviral therapy: factors independently associated with reported difficulty taking antiretroviral therapy in a national sample of HIV-positive Australians

Abstract

ObjectivesGiven the importance of adherence to combination antiretroviral therapy (cART) for the reduced morbidity and improved mortality of people living with HIV infection (PLWH), we set out to determine which of a number of previously investigated personal, socioeconomic, treatment-related and disease-related factors were independently associated with self-reported difficulty taking antiretroviral therapy (ART) in an Australian sample of PLWH. MethodsUsing data from a national cross-sectional survey of 1106 PLWH, we conducted bivariate and multivariable analyses to assess the association of over 70 previously investigated factors with selfreported difficulty taking ART. Factors that maintained an association with reported difficulty taking ART at the level of a 5 0.05 in the multivariable logistic regression analysis were considered to be independently associated with reported difficulty taking ART. ResultsA total of 867 (78.4%) survey respondents were taking antiretroviral medication at the time of completing the HIV Futures 6 survey. Overall, 39.1% of these respondents reported difficulty taking ART. Factors found to be independently associated with reported difficulty taking ART included younger age, alcohol and party drug use, poor or fair self-reported health, diagnosis of a mental health condition, living in a regional centre, taking more than one ART dose per day, experiencing physical adverse events or health service discrimination, certain types of ART regimen and specific attitudes towards ART and HIV. ConclusionsThirteen previously investigated factors were found to be independently associated with reported difficulty taking ART, reaffirming the dynamic nature of adherence behaviour and the ongoing importance of addressing adherence behaviour in the clinical management of PLWH.Keywords: adherence, antiretroviral therapy, Australia, HIV, nonadherence IntroductionCombination antiretroviral therapy (cART) has revolutionized the course of HIV disease, transforming HIV infection from a life-threatening infection to a manageable chronic condition, particularly in developed countries [1][2][3]. However, a key challenge is the high level of adherence to cART that is required for viral suppression, immunological response and reduced morbidity and mortality in individuals with HIV/AIDS [4][5][6]. Studies have demonstrated a requirement for adherence levels of at least 95% in order to achieve adequate viral suppression for regimens including unboosted protease inhibitor (PI) therapy [4,7]. While a lower level of adherence has been shown to lead to viral suppression when using nonnucleoside reverse transcriptase inhibitor (NNRTI) regimens [7], the development of treatment-resistant mutations has been shown to peak at approximately 70% adherence and there is an ongoing decline in the rate of developing treatmentresistant mutations towards 100% adherence, providing a DOI: 10.1111/j.1468-1293.2011.00928.x HIV Medicine (2011 r 2011 British HIV Association 562 further imperative for achieving near-perfect adhere...

Safety Assessment of Potentially Inappropriate Medications Use in Older People and the Factors Associated with Hospital Admission

“…Moreover, there is a problem of nonadherence to pharmacotherapy in users of alcohol [24] and tobacco [25] with chronic diseases (e.g. AIDS), that could increase the prevalence of DRP; NOM and failure of the treatment.…”

La mala calidad de sueño se asocia a una menor adherencia al tratamiento antirretroviral de gran actividad en pacientes peruanos con infección por VIH/SIDA

“…No obstante, como variable genérica la comorbilidad fue incluida en los modelos de regresión ajustados al considerase un confusor importante. Además de ello, se debe comentar que no se pudo evidenciar como en otros estudios, el efecto del alcohol en la calidad del sueño y en la adherencia, pues no fue significativamente asociado 22,23,26,28 .…”

“…Sin embargo, la adherencia se ve afectada por múltiples factores, en particular por los efectos secundarios del tratamiento 17,18,19,20 . Problemas de salud mental como la depresión 21 , así como el consumo de alcohol 22,23 y el abuso de sustancias, se asocian también a una baja adherencia al tratamiento 20,24,25,26,27,28,29 . Además, se ha encontrado asociación con efectos adversos específicos de los antirretrovirales 30,31 , entre otras causas 32,33 .…”

Living with HIV in regional Queensland: social ties, care and support in managing a long-term complex chronic illness

“…The literature suggests that financial stress may be an under-reported phenomenon among positive people living rurally and remotely in high-income settings [19][20][21][22]. In this study, out of 32 participants 17 lived in social housing, shared housing, or lived with their families (rent-free).…”

“…What is known, is that managing HIV can be compounded by a history of stigma, complex psycho-social needs, multiple comorbidities, premature aging and progressive social and economic precariousness [8-10, 12, 14-18]. Living regionally may be associated with an additional set of challenges, such as difficult access to services, financial stress, heightened risk of stigma and discrimination, and social isolation 6 [19][20][21][22][23][24][25]. Living with HIV therefore has greater psychological, social and economic impact than the sum of the biomedical factors.…”