Dual Trajectories of Antiretroviral Therapy Adherence and Polypharmacy in Women with HIV in the United States

Abstract

Background Polypharmacy, using five or more medications, may increase the risk of nonadherence to prescribed treatment. We aimed to identify the interrelationship between trajectories of adherence to antiretroviral therapy (ART) and polypharmacy. Methods We included women with HIV (aged ≥ 18) enrolled in the Women's Interagency HIV Study in the United States from 2014 to 2019. We used group-based trajectory modeling (GBTM) to identify trajectories of adherence to ART and polypharmacy and the dual GBTM to identify the interrelationship between adherence and polypharmacy. Results Overall, 1,538 were eligible (median age of 49 years). GBTM analysis revealed five latent trajectories of adherence with 42% of women grouped in the consistently moderate trajectory. GBTM identified four polypharmacy trajectories with 45% categorized in the consistently low group. Conclusions The joint model did not reveal any interrelationship between ART adherence and polypharmacy trajectories. Future research should consider examining the interrelationship between both variables using objective measures of adherence.

Beyond Undetectable: Modeling the Clinical Benefit of Improved Antiretroviral Adherence in Persons With Human Immunodeficiency Virus With Virologic Suppression

“…Conversely to our estimation on the risk reduction on SNAE or death driven by an increase in adherence, we also aimed to estimate the number of PWH who would need to reduce adherence before an additional SNAE or death were to be observed. This approach was selected as we assumed that most PWH who achieve viral suppression are highly adherent to ART at some point during the course of their treatment (eg, early stage of treatment initiation) [ 24 , 25 ], but that a decrease in adherence—without the development of viremia—is expected in some patients [ 2 , 3 ]. To achieve this, we used a simplified version of the Markov model developed by Serrano-Villar et al [ 26 ], where we inputted the change in biomarkers available in the literature to estimate the number of PWH who would need to reduce adherence before an additional SNAE or death is observed.…”