Determinants of adherence to highly active antiretroviral therapy (HAART) in Chinese HIV/AIDS patients

Abstract

ObjectiveDrug adherence is crucial to the success of highly active antiretroviral therapy (HAART) in the treatment of HIV disease. Adherence to HAART and its determinants may, however, differ across HIV/AIDS populations. MethodsWe retrospectively studied drug adherence by self-report in HIV-1 infected Chinese patients who have been on HAART for at least 1 year as at the end of year 2000. HAART is de®ned as three or more antiretrovirals with at least one protease inhibitor or non-nucleoside analogue reverse transcriptase inhibitor. ResultsThe last drug adherence level assessed by self-report in 161 Chinese patients were: grade A (100%) ± 130, 80.7%; grade B (95±99%) ± 25, 15.5%; grade C (90±94%) ± three, 1.9% and grade D (< 90%) ± three, 1.9%. Patients with full adherence were more likely to have undetectable (< 500 copies/mL) plasma virus level (adjusted OR, 4.22; 95% CI, 1.75±12.33). Patients' demographics, HIV disease status and antiretroviral regimen did not affect adherence. Partial drug adherence was, however, independently associated with the psychosocial factors of missing clinic appointments (adjusted OR, 3.13; 95% CI, 1.23±8.33), forgetfulness (adjusted OR, 4.55; 95% CI, 1.64±12.5) and a busy work life (adjusted OR, 6.67; 95% CI, 1.75±25). ConclusionThere were similarities and differences in determinants affecting HAART adherence in Chinese compared with other patients. Psychosocial factors rather than HIV disease or treatment were more important factors in our Chinese patients. The relevance of patient populations and care setting for adherence to HAART shall be further studied. IntroductionMorbidity and mortality among patients with HIV infection has declined with the advent of highly active antiretroviral therapy (HAART) [1,2]. To have maximal suppression of plasma virus load beyond detection limit is the laboratory target for gauging success of HAART. However, factors such as prior exposure to antiretrovirals [3], advanced HIV disease [4] and suboptimal drug adherence [5] were shown to affect the likelihood of prolonged virus suppression. Furthermore, since antiretroviral therapy is a long-term treatment, and not without side effects, maintaining a high level of drug adherence often represents a big challenge for both the patient and healthcare provider [6]. To maximally substantiate the bene®ts of HAART, measures to continually monitor and enhance patients' drug adherence has become indispensable for effective HIV management nowadays [7].Unfortunately, availability of HAART for treating HIV/AIDS patients has so far been largely limited to the developed Western countries. Hence, most studies on drug adherence to HAART had originated from these countries. A variety of factors has been found to predict antiretroviral MethodsThis was a retrospective study conducted at one of the largest HIV clinical services in Hong Kong ± the Integrated Treatment Centre of the Department of Health. In early 1997, shortly after the availability of HAART in our clinic, we commenced a drug adherence counselling program...

Adherence to antiretroviral therapy and factors affecting adherence among paediatric HIV patients

“…Similar observations were also noticed by De Bruin et al 20 In our study, use of various different ART regimens had no impact on adherence (p=0.990). This was in accordance with findings of Fong et al 21 In contrast, Laniece et al found that the type of drug combination influences adherence. 19 We did not find any association between ART regimens with adherence, but we found association between adherence and medication sideeffects that were experienced within the last month.…”

Longitudinal Antiretroviral Adherence in HIV+ Ugandan Parents and Their Children Initiating HAART in the MTCT-Plus Family Treatment Model: Role of Depression in Declining Adherence Over Time

“…These high levels of adherence confirm findings in other resource-limited settings (Byakika-Tusiime et al 2005;Fong et al 2003;Landman et al 2003;Laniece et al 2003;Laurent et al 2004;Laurent et al 2005a, b;Nachega et al 2004;Orrell et al 2003;Oyugi et al 2004;Remien et al 2003;Weidle et al 2002;Weiser et al 2003). Our findings contrast with those of Merenstein et al (2008), who found an inverse relationship between adherence and the number of children in the family.…”

“…While most studies have shown high levels of adherence to ART in resource-constrained settings Bisson et al 2008;Byakika-Tusiime et al 2005;Diabate et al 2007;Etard et al 2007;Fong et al 2003;Landman et al 2003;Laniece et al 2003;Laurent et al 2004;Laurent et al 2005a, b;Mills et al 2006b;Nachega et al 2004;Orrell et al 2003;Oyugi et al 2004;Remien et al 2003;San Lio et al 2008;Tadios and Davey 2006;Weidle et al 2002;Weidle et al 2006;Weiser et al 2003) there has been little discussion about how HIV? women balance the demands of adherence to HIV ART, childcare, and antiretroviral adherence among their children who are HIV-infected.…”

Sero-positive African Americans’ Beliefs about Alcohol and Their Impact on Anti-retroviral Adherence

“…Repeated attempts to identify individual traits or characteristics (e.g., demographics) that correlate with adherence have failed (Reynolds, 2004), although several studies have associated older age with increased adherence (e.g., Hinkin, Hardy, & Hardy, 2004). Attention has thus shifted to potentially improving adherence by identifying modifiable features associated with adherence such as substance use (Ferrando, Wall, Batki, & Sorensen, 1996), depression (Arnsten et al, 2002), forgetfulness (Fong et al, 2003), and isolation (Altice, Mostashari, & Friedland, 2001). …”