Clinical and Economic Outcomes of Nonadherence to Highly Active Antiretroviral Therapy in Patients With Human Immunodeficiency Virus

Munakata, Julie; Benner, Joshua S.; Becker, Stephen; Dezii, Christopher M.; Hazard, Elisabeth; Tierce, Jonothan C.

doi:10.1097/01.mlr.0000233679.20898.e9

Cited by 44 publications

(41 citation statements)

References 43 publications

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“…One large retrospective study found that high rates of medication adherence were associated with lower disease-related medical costs and significantly lower hospitalization rates for patients with diabetes, hypertension, hypercholesterolemia, and congestive heart failure [10]. Similar relationships were observed when adherence and health care costs were analyzed in patients with HIV [11] and osteoporosis [12].…”

Section: Introductionmentioning

confidence: 74%

Patient adherence to tyrosine kinase inhibitor therapy in chronic myeloid leukemia

et al. 2012

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Dramatically improved survival associated with tyrosine kinase inhibitor (TKI) therapy has transformed the disease model for chronic myeloid leukemia (CML) to one of long-term management, but treatment success is challenged with poor medication adherence. Many risk factors associated with poor adherence can be ameliorated by close monitoring, dose modification, and supportive care. Controlling risk factors for poor adherence in combination with patient education that includes direct communication between the health care team and the patient are essential components for maximizing the benefits of TKI therapy. Am. J. Hematol. 87:687-691, 2012. V V C 2012 Wiley Periodicals, Inc. IntroductionThe last three decades have witnessed extraordinary advances in the treatment of chronic diseases, among which tyrosine kinase inhibitor (TKI) therapy for chronic myeloid leukemia (CML) is perhaps one of the most outstanding examples. Between 1975 and 1977, the 5-year relative survival rate of patients with CML was only 24% [1]. Allogeneic stem cell transplantation offered a potential cure for a small subset of patients; however, the risk of serious infection, graft-versus-host disease, relapse, and mortality presented substantial limitations [2,3]. The introduction of imatinib (Gleevec 1 , Novartis Pharmaceuticals Corporation, East Hanover, NJ) in 2001 replaced interferon-a as the standard of care for CML patients, with a result of remarkable improvement in patient survival. For example, the 8-year follow-up analysis of imatinib treatment in 553 CML patients participating in the International Randomized Study of Interferon versus STI571 demonstrated an overall survival (OS) rate of 85%; OS was 93% when only CMLrelated deaths and those before stem cell transplantation are considered [4]. With this prolonged survival and the recent approval of the more potent agents nilotinib (Tasigna 1 , Novartis Pharmaceuticals Corporation, East Hanover, NJ) and dasatinib (Sprycel 1 , Bristol-Myers Squibb Company, Princeton, NJ), which may be able to provide additional survival benefit, CML more closely resembles a chronic rather than a fatal disease. A new challenge has arisen, however, stemming directly from the success of TKI therapy. Poor medication adherence has come into focus as a major impediment to successful treatment of patients with CML: New evidence has shown that inadequate adherence to imatinib and suboptimal outcomes are inextricably linked [5][6][7].Difficulty in maintaining high medication adherence is not limited to TKI therapy or patients with CML, however. Indeed, the problem is pervasive across chronic conditions. For example, a 2003 report from the World Health Organization found the average rate of long-term adherence for diseases such as asthma, diabetes, hypertension, and tuberculosis was only about 50% in developed countries, and assumed to be even lower in developing countries where health resources are fewer and access to care is unpredictable [8]. The report identified five key areas that affect adherence, includin...

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Section: Introductionmentioning

confidence: 74%

Patient adherence to tyrosine kinase inhibitor therapy in chronic myeloid leukemia

et al. 2012

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“…Nonadherence is an important predictor for losing the long-term clinical and economic benefits of ART. Munakata et al 12 reported that nonadherence with treatment reduced the expected clinical benefits of ART by 12%. Our results suggest that interventions improving adherence to ideal levels also have great potential for economic benefit, especially in developing countries without alternative treatment regimens.…”

Section: Adherence and Medical Costmentioning

confidence: 99%

“…10 Other positive outcomes related to ART, including decreased hospital readmissions and reduced cost, have been described by some western studies. 11,12 Published literature regarding adherence to ART and treatment outcomes among Chinese HIV=AIDS patients is limited. Two current studies have assessed the levels of adherence to ART and associated factors in Chinese populations.…”

Section: Introductionmentioning

confidence: 99%

Consistent ART Adherence Is Associated with Improved Quality of Life, CD4 Counts, and Reduced Hospital Costs in Central China

Wang

Zhou

et al. 2009

AIDS Research and Human Retroviruses

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This study aimed to assess levels of ART adherence and to examine the relationship between adherence and treatment outcomes. A longitudinal study in Hunan and Hubei provinces used the CPCRA Antiretroviral Medication Self-Report and a 7-day Visual Analogue Scale to assess levels of adherence, while quality of life was evaluated using SF-36. CD4 cell count and the number, duration, and cost of hospitalizations were collected from participant medical records. Measurements were obtained at baseline, month 3, and month 6. A total of 113 participants enrolled and 98 completed the study. The mean level of adherence was 91%, 89%, and 88% at baseline and at 3 and 6 months, respectively. Of participants, 54=98 (58%) reported taking all doses at all three interviews and were classified as consistent adherers (CA). CAs had better physical function ( p ¼ 0.001), general health ( p ¼ 0.009), vitality ( p ¼ 0.016), social functioning ( p ¼ 0.001), and mental health ( p ¼ 0.023), and presented a higher CD4 cell count ( p ¼ 0.028). CAs also had fewer hospital admissions and readmissions ( p ¼ 0.005), shorter hospital stays ( p ¼ 0.005), and lower hospital expenses ( p ¼ 0.006). Consistent adherence is associated with better outcomes including improved quality of life, higher CD4 counts, and lower health care costs.

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“…However, it has been reported that young adults have poorer rates of retention in care than older adults, suggesting that young adults are more at risk for being lost to follow-up. 6,7 For HIV-positive patients, adherence to ART to the point of viral suppression can lower the risks of disease progression and death, 8,9 reduce overall health care costs, 10 and, potentially, decrease HIV transmission. 11 Despite improvements in ART regimens with regard to dosing frequency, dosing constraints (i.e., food restrictions), storage conditions, and adverse effects, 12 drug adherence remains a significant problem.…”

Section: Introductionmentioning

confidence: 99%

Baseline Clinical Characteristics, Antiretroviral Therapy Use, and Viral Load Suppression Among HIV-Positive Young Men of Color Who Have Sex with Men

Hightow-Weidman

Jones

Phillips

et al. 2011

AIDS Patient Care and STDs

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Given the continued high incidence of HIV infection in the United States among racial/ethnic minority young men who have sex with men (YMSM), and an appreciation that antiretroviral therapy (ART) can provide personal and public health benefits, attention is needed to enhance the detection of HIV-infected youth and engage them in medical care and support services that encourage sustained HIV treatment and suppression of viremia. Poor retention in clinical care has been associated with higher mortality, an increase in HIV RNA, and decreased CD4 cell count. The goal of the current study was to evaluate the health care utilization and health outcomes of HIV-infected racial/ethnic minority YMSM enrolled in an outreach, linkage, and retention study funded by the Health Resources and Services Administration (HRSA) HIV/AIDS Bureau (HAB). We hypothesized that among racial/ethnic minority YMSM, baseline CD4 counts and usage of ART are influenced by age, race, drug and alcohol use, and mental health symptoms. Overall, 155 subjects had at least a baseline CD4 count recorded at study entry. There was a low rate of ART use in this population with only one-half of the cohort with CD4 counts £ 350 cells/mm 3 being prescribed ART to treat their infection. However, of those youth who were started on ART, the majority (74%) did achieve undetectable viral loads ( < 400 copies). Given the continued increase in cases of HIV infection among racial/ethnic minority YMSM, efforts to increase both the provision of ART and support services that encourage adherence in this population are warranted.

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Clinical and Economic Outcomes of Nonadherence to Highly Active Antiretroviral Therapy in Patients With Human Immunodeficiency Virus

Abstract: Typical adherence with HAART reduces quality-adjusted life expectancy by 12% compared with ideal adherence. Interventions to improve adherence appear to be a highly cost-effective use of resources.

Cited by 44 publications

References 43 publications

Patient adherence to tyrosine kinase inhibitor therapy in chronic myeloid leukemia

Patient adherence to tyrosine kinase inhibitor therapy in chronic myeloid leukemia

Consistent ART Adherence Is Associated with Improved Quality of Life, CD4 Counts, and Reduced Hospital Costs in Central China

Baseline Clinical Characteristics, Antiretroviral Therapy Use, and Viral Load Suppression Among HIV-Positive Young Men of Color Who Have Sex with Men

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