Differential predictors of ART adherence among HIV-monoinfected versus HIV/HCV-coinfected individuals

Abstract

Although adherence is an important key to the efficacy of antiretroviral therapy (ART), many people living with HIV (PLWH) fail to maintain optimal levels of ART adherence over time. PLWH with the added burden of Hepatitis C virus (HCV) coinfection possess unique challenges that potentially impact their motivation and ability to adhere to ART. The present investigation sought to (1) compare ART adherence levels among a sample of HIV/HCV-coinfected versus HIV-monoinfected patients, and (2) identify whether ART-related clinical and psychosocial correlates differ by HCV status. PLWH receiving ART (N = 215: 105 HIV/HCV-coinfected, 110 HIV-monoinfected) completed a comprehensive survey assessing ART adherence and its potential correlates. Medical chart extraction identified clinical factors, including liver enzymes. Results demonstrated that ART adherence did not differ by HCV status, with 83.7% of coinfected patients and 82.4% of monoinfected patients reporting optimal (i.e., ≥95%) adherence during a four-day recall period (p = .809). Multivariable logistic regression demonstrated that regardless of HCV status, optimal ART adherence was associated with experiencing fewer adherence-related behavioral skills barriers (AOR = 0.56; 95%CI = 0.43-0.73), lower likelihood of problematic drinking (AOR = 0.15; 95%CI = 0.04-0.67), and lower likelihood of methamphetamine use (AOR = 0.14; 95%CI = 0.03-0.69). However, among HIV/HCV-coinfected patients, optimal adherence was additionally associated with experiencing fewer ART adherence-related motivational barriers (AOR = 0.23; 95%CI = 0.08-0.62) and lower likelihood of depression (AOR = 0.06; 95%CI = 0.00-0.84). Findings suggest that although HIV/HCV-coinfected patients may face additional, distinct barriers to ART adherence, levels of adherence commensurate with those demonstrated by HIV-monoinfected patients might be achievable if these barriers are addressed.

Substance Use and Adherence to Antiretroviral Therapy: What Is Known and What Is Unknown

“…Of note, in many of these same studies [24, 26, 27, 25], cannabis use was not a risk for suboptimal ART adherence. This lack of association between cannabis use and ART adherence was also documented in other recent analyses [30–32].…”

“…A recent review examining the impacts of alcohol on the HIV cascade of care continuum published between 2010 and 2015 found an association between alcohol use and nonadherence, usually in a dose-response fashion, in most (n=16) of the 33 included studies focusing on the ART adherence step [22]. Other recent studies confirm this negative influence of alcohol on ART adherence in a variety of contexts [23, 17, 24, 25]. …”

“…Recent research continues to support this negative association [25, 37, 38]. Indeed, in one of these studies, ART non-adherence was more likely to occur in days where methamphetamine was also used [38].…”

HBV, HCV, and HBV/HCV co‐infection among HIV‐positive patients in Hunan province, China: Regimen selection, hepatotoxicity, and antiretroviral therapy outcome

“…The majority of HCV co-infected patients in this study were PWID (69.2%), and this population usually has an unstable lifestyle, and a significant proportion (estimated 90%) of them continue to use drugs after initiating ART. 45 Low ART adherence among drug users was reported in previous studies, 46,47 which may further reduce the treatment benefits of ART and increase the treatment failure risk.…”

“…A total of 1984 PLHIV initiating ART and were tested for HBV and HCV at baseline (Table 1). The median age of patients was 39 years (IQR [30][31][32][33][34][35][36][37][38][39][40][41][42][43][44][45][46][47][48][49], and the median CD4+ T-cell count was 152 cells/mm 3…”