Estudios de adherencia a los fármacos antirretrovirales. Una revisión sistemática

Puigventós, Francesc; Riera, Melcior; Delibes, Carla; Peñaranda, María Luz Pintos; Fuente, Laura de la; Boronat, Assumpció

doi:10.1016/s0025-7753(02)73341-1

Cited by 35 publications

(25 citation statements)

References 63 publications

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“…DOT-HAART was found to improve HAART adherence, supporting the presumed mechanism of DOT-HAART effectiveness on clinical outcomes through improved antiretroviral adherence. 4,9,102,103 Qualitative data suggest that other mechanisms may also mediate DOT-HAARTeffectiveness, including positive effects on patients’ trust and communication with providers; increased patient motivation to engage in daily activities and become involved in the community; improved adherence to other aspects of medical care; and greater the utilization of other forms of social and adherence support. 30,44,65,104–106 …”

Section: Discussionmentioning

confidence: 99%

Effect of Directly Observed Therapy for Highly Active Antiretroviral Therapy on Virologic, Immunologic, and Adherence Outcomes: A Meta-Analysis and Systematic Review

Hart¹,

Jeon²,

Ivers³

et al. 2010

JAIDS Journal of Acquired Immune Deficiency Syndromes

104

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Introduction Directly observed therapy of highly active antiretroviral therapy (DOT-HAART) is a feasible adherence intervention. Prospective DOT-HAART studies have shown mixed results, and optimal target groups have yet to be defined. We performed a meta-analysis and systematic review to assess the effect of DOT-HAART on adherence and virologic and immunologic response. Methods We performed a comprehensive search through August 2009 to identify peer-reviewed controlled studies that involved outpatient DOT-HAART among adults and reported at least 1 outcome assessed in this meta-analysis. Random-effects meta-analyses were performed; differences in effect on virologic suppression were examined using stratified meta-analyses and meta-regression on several study characteristics. Results Seventeen studies met inclusion criteria. Compared with control groups, DOT-HAART recipients were more likely to achieve an undetectable viral load (random effects risk ratio 1.24, 95% confidence interval (CI): 1.08 to 1.41), a greater increase in CD4 cell count (random effects weighted mean difference 43 cells/μL, 95% CI: 12 to 74 cells/μL), and HAART adherence of ≥95% (random effects risk ratio 1.17, 95% CI: 1.03 to 1.32). Results varied with respect to virologic response. DOT-HAART did not have a significant effect on virologic suppression when restricted to randomized controlled studies. Post-treatment effect was not observed in a limited number of studies. Conclusions DOT-HAART had a significant effect on virologic, immunologic, and adherence outcomes, although its efficacy was not supported when restricting analysis to randomized controlled trials. DOT-HAART shows greatest treatment effect when targeting individuals with greater risk of nonadherence and when delivering the intervention that maximizes participant convenience and provides enhanced adherence support. Further investigation is needed to assess the postintervention effect and cost-effectiveness of DOT-HAART.

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Section: Discussionmentioning

confidence: 99%

Effect of Directly Observed Therapy for Highly Active Antiretroviral Therapy on Virologic, Immunologic, and Adherence Outcomes: A Meta-Analysis and Systematic Review

Hart¹,

Jeon²,

Ivers³

et al. 2010

JAIDS Journal of Acquired Immune Deficiency Syndromes

104

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“…However, the transition from academic research setting to clinical patient care has yet to be realized. The needs, nonetheless, to make nanoART accessible are immediate as limitations in ART adherence, drug fatigue, emergence of viral resistance, and restrictions of drug penetration to viral reservoirs abound [3–5]. Daily or twice daily drug administrations have a myriad of restrictions in resource-limited settings, during co-morbid conditions such as malabsorption syndromes and by concomitant substance abuse.…”

Section: Introductionmentioning

confidence: 99%

Pharmacodynamics of long-acting folic acid-receptor targeted ritonavir-boosted atazanavir nanoformulations

et al. 2015

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Long-acting nanoformulated antiretroviral therapy (nanoART) that target monocyte-macrophage could improve the drug’s half-life and protein binding capacities while facilitating cell and tissue depots. To this end, ART nanoparticles that target the folic acid (FA) receptor and permit cell-based drug depots were examined using pharmacokinetic and pharmacodynamic (PD) tests. FA receptor-targeted poloxamer 407 nanocrystals, containing ritonavir-boosted atazanavir (ATV/r), significantly affected several therapeutic factors: drug bioavailability increased as much as 5 times and PD activity improved as much as 100 times. Drug particles administered to human peripheral blood lymphocyte reconstituted NOD.Cg-PrkdcscidIl2rgtm1Wjl/SzJ mice and infected with HIV-1ADA at a tissue culture infective dose50 of 104 infectious viral particles/ml led to ATV/r drug concentrations that paralleled FA receptor beta staining in both the macrophage-rich parafollicular areas of spleen and lymph nodes. Drug levels were higher in these tissues than what could be achieved by either native drug or untargeted nanoART particles. The data also mirrored potent reductions in viral loads, tissue viral RNA and numbers of HIV-1p24+ cells in infected and treated animals. We conclude that FA-P407 coating of ART nanoparticles readily facilitate drug carriage and facilitate antiretroviral responses.

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“…Although some systematic reviews on adherence to antiretroviral therapy attempting to elucidate these questions have been published, [27][28][29] their results have not been unanimous. For example, while Puigventos [27] identifies a wide number of sociodemographic, health and clinical factors related to adherence from thirty studies worldwide, Mills [28] shows that the region where the study was conducted, adherence thresholds, and study quality can explain the variability in levels of adherence.…”

Section: Introductionmentioning

confidence: 99%

“…For example, while Puigventos [27] identifies a wide number of sociodemographic, health and clinical factors related to adherence from thirty studies worldwide, Mills [28] shows that the region where the study was conducted, adherence thresholds, and study quality can explain the variability in levels of adherence. On the other hand, Malta [29] finds that active substance use, depression and low social support are associated with poor adherence.…”

Section: Introductionmentioning

confidence: 99%

Adherence to Highly Active Antiretroviral Therapy (HAART): A Meta-Analysis

et al. 2011

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This meta-analysis synthesizes eighty-four observational studies, conducted across twenty countries, to determine the mean proportion of people who reported ≥90% adherence to prescribed highly active antiretroviral therapy (HAART) and to identify the factors associated with high levels of adherence. Eight electronic databases were searched to locate all relevant studies available by January 2010, which were then coded for sample characteristics and adherence levels. The average rate of reporting ≥90% adherent HAART adherence is 62%. However, this proportion varies greatly across studies. In particular, a greater proportion of individuals maintaining ≥90% adherence to HAART is more likely in studies with higher proportions of men who have sex with men (MSM) and lower proportions of injection drug users (IDU), with participants in an earlier stage of infection, and in studies conducted in countries characterized by lower Human Development Index (HDI) scores.

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Estudios de adherencia a los fármacos antirretrovirales. Una revisión sistemática

Cited by 35 publications

References 63 publications

Effect of Directly Observed Therapy for Highly Active Antiretroviral Therapy on Virologic, Immunologic, and Adherence Outcomes: A Meta-Analysis and Systematic Review

Effect of Directly Observed Therapy for Highly Active Antiretroviral Therapy on Virologic, Immunologic, and Adherence Outcomes: A Meta-Analysis and Systematic Review

Pharmacodynamics of long-acting folic acid-receptor targeted ritonavir-boosted atazanavir nanoformulations

Adherence to Highly Active Antiretroviral Therapy (HAART): A Meta-Analysis

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