Assessment and Predictors of Antiretroviral Adherence in Older HIV-Infected Patients

Abstract

Advances in the diagnosis and treatment of HIV disease have resulted in increased survival for HIV-infected patients. Strict adherence to antiretroviral therapy is required to obtain these benefits, however. This holds true for older patients who often are diagnosed later in their disease course and who have shorter survival periods than younger patients. Although there have been few studies of antiretroviral adherence in older HIV patients, this article reviews the literature regarding antiretroviral adherence in younger HIV-infected adults as well as studies of medication adherence in older patients with other disease states. It then discusses the application of adherence interventions in these other populations to older HIV-infected adults. Several methods have been used in measuring antiretroviral adherence, including electronic monitoring, self-report, pill counts, viral load, therapeutic drug monitoring, and several other techniques. The advantages and disadvantages of these methods also are presented as well as recommendations for future adherence research in older HIV-infected adults. Finally, this article details areas of unmet research need concerning HIV medication adherence in older adults.

Objectively Measured, but Not Self-Reported, Medication Adherence Independently Predicts Event-Free Survival in Patients With Heart Failure

“…[26][27] Fourth, the MEMS can assess short-term and long-term adherence. 32 Self-report medication adherence was assessed using one item from the Medical Outcomes Study (MOS) Specific Adherence Scale. [33][34] The MOS Specific Adherence Scale was developed for patients with diabetes, hypertension, and heart disease.…”

Age-Related Changes in Plasma Concentrations of the HIV Protease Inhibitor Lopinavir

“…45 These effects include a lower absolute CD4 þ lymphocyte count increase in response to HAART 46 and slower rates of CD4 þ lymphocyte recovery, [47][48][49] a decreased proportion of naive CD4 þ cells in untreated individuals, and diminished naive CD4 þ cell restoration, 50-53 although some investigators report no age-related changes in these parameters. 38,49 Several factors could explain age-related changes in LPV pharmacokinetics.…”

Assessing Antiretroviral Adherence via Electronic Drug Monitoring and Self-Report: An Examination of Key Methodological Issues

“…(p. 1117). Recent comprehensive reviews of HAART-specific adherence assessment methods leave many methodological questions unanswered (Ammassari et al, 2002;Liu et al, 2001;Miller and Hays, 2000a;Paterson, Potoski, & Capitano, 2002;Turner, 2002;Wutoh et al, 2003).…”