Impact of different patterns of nonadherence on the outcome of highly active antiretroviral therapy in patients with long‐term follow‐up

Abstract

ObjectivesThe aim of the study was to evaluate the impact of different patterns of nonadherence on treatment outcomes in patients with long-term follow-up. MethodsThis cohort study included patients who began highly active antiretroviral therapy during 1996-1999, with the last follow-up in 2007. Adherence was evaluated every 2 months by monitoring of pharmacy refills and by using self-reports. Patients were considered nonadherent at a specific visit when less than 90% of the prescribed drugs had been taken. Adherence was categorized as follows. (A) Continuous adherence: a patient had to be adherent in all of the evaluations throughout the period of follow-up. (B) Treatment interruption: drugs were not taken for more than 3 days, for any reason. Treatment failure was defined as viral load 4500 HIV-1 RNA copies/mL or death. Cox proportional risk models were used to calculate adjusted relative hazards (ARHs) of treatment failure. ResultsA total of 540 patients were included in the study, with a median follow-up of 8.3 years. Only 32.78% of patients achieved and maintained continuous adherence, and 42.78% of patients had treatment interruptions. Noncontinuous adherence [ARH 1.48; 95% confidence interval (CI) 1.02-2.14] and treatment interruptions (ARH 1.39; 95% CI 1.04-1.85) were associated with treatment failure for the overall cohort; however, for patients with more than 3 years of follow-up, only treatment interruptions were independently associated with treatment failure. ConclusionsOnly one-third of patients managed to achieve continuous adherence, and almost half of the patients had treatment interruptions, which have a particularly marked effect on treatment outcomes over the long term. IntroductionThe goals of HIV infection treatment are to suppress viraemia, to improve immune function and to delay disease progression over the long term [1,2]. Different factors affect the effectiveness of antiretroviral therapy (ART), such as the level of plasma HIV RNA, the degree of immunodeficiency and drug resistance; however, nonadherence may be the most important challenge to achieving the goals of ART.Previous studies have emphasized the effect of adherence on virological, immunological and survival endpoints [3][4][5][6][7][8].A high level of adherence to combined ART is essential to minimize the risk of treatment failure. However, the level of adherence necessary to obtain and maintain virological suppression may vary according to the type of ART [9,10].Nonadherence is a dynamic process; it varies over time, and may be expressed in different forms, such as a 'missed dose phenomenon ' [11,12] focused on quantitative and global measures, and only a few studies have reported data beyond 3 years of follow-up [13][14][15]. The aim of this study was to evaluate the impact of different patterns of nonadherence (missed doses and treatment interruptions) on the risk of treatment failure in HIV-infected patients with long-term follow-up. Patients and methodsThis cohort study analysed data of HIV-infected patients older tha...

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