Non‐medically supervised treatment interruptions among participants in a universally accessible antiretroviral therapy programme

Abstract

We examined clinical outcomes, patient characteristics and trends over time of non-medically supervised treatment interruptions (TIs) from a free-of-charge antiretroviral therapy (ART) programme in British Columbia (BC), Canada. MethodsData from ART-naïve individuals 18 years old who initiated triple combination highly active antiretroviral therapy (HAART) between January 2000 and June 2006 were analysed. Participants having 3 month gap in HAART coverage were defined as having a TI. Cox proportional hazards modelling was used to examine factors associated with TIs and to examine factors associated with resumption of treatment. ResultsA total of 1707 participants were study eligible and 643 (37.7%) experienced TIs. TIs within 1 year of ART initiation decreased from 29% of individuals in 2000 to 19% in 2006. TIs were independently associated with a history of injection drug use (IDU) (P 5 0.02), higher baseline CD4 cell counts (Po0.001), hepatitis C co-infection (Po0.001) and the use of nelfinavir (NFV) (P 5 0.04) or zidovudine (ZDV)/lamivudine (3TC) (P 5 0.009) in the primary HAART regimen. Male gender (Po0.001), older age (Po0.001), AIDS at baseline (P 5 0.008) and having a physician who had prescribed HAART to fewer patients (P 5 0.03) were protective against TIs. Four hundred and eightyeight (71.9%) participants eventually restarted ART with male patients and those who developed an AIDS-defining illness prior to their TI more likely to restart therapy. Higher CD4 cell counts at the time of TI and unknown hepatitis C status were associated with a reduced likelihood of restarting ART. ConclusionTreatment interruptions were associated with younger, less ill, female and IDU participants. Most participants with interruptions eventually restarted therapy. Interruptions occurred less frequently in recent years.Keywords: access to therapy, adherence, antiretroviral therapy, treatment interruptions Introduction Improving access to highly active antiretroviral therapy (HAART) is an important public health objective in all regions of the globe. Not only is HAART associated with markedly improved survival among HIV-infected individuals [1,2], but it can also contribute to reducing the number of new HIV infections at the population level [3,4]. Continued access to HAART is often limited by patientincurred costs, especially in low-or middle-income countries [5] [7,8]. Furthermore, among individuals who have started on HAART, discontinuation rates have been shown to vary greatly from 6% [9] to 51% at 1 year of follow-up [10][11][12][13]. Given the compelling public health need to ensure that as many people benefit from HAART as possible, trying to re-engage individuals who have initiated HAART but have later interrupted therapy should be seen as a priority. However, few studies have examined the characteristics and outcomes of patients who have interrupted HAART. When examining these issues, it is important to distinguish nonmedically supervised treatment interruptions (TIs) from structured TIs, which were considered to be ...

Women and Vulnerability to HAART Non-Adherence: A Literature Review of Treatment Adherence by Gender from 2000 to 2011

“…It has been found that women have reduced uptake of ART [24,25], higher incidence of treatment interruption [26,27], treatment discontinuation [28], and viral rebound after initial suppression than men [8,29,30]. Mediating factors that may influence these findings include increased development of depressive symptoms in women [9•, 31, 32], reduced disclosure of serostatus [33], and support from interpersonal relationships [21].…”

Differences in Response to Antiretroviral Therapy by Sex and Hepatitis C Infection Status

“…While some studies have found no association of sex with response to ART, [17][18][19] others have suggested that women have superior virologic, immunologic, and clinical outcomes compared with men. [20][21][22][23][24] It is unknown if this is attributable to biological factors, such as pharmacokinetics, 25,26 or behavioral or structural factors, such as adherence 27 or access to or quality of care. 28 Despite evidence that there may be sex differences in both the course of HCV disease and the response to ART among HIV-infected individuals, there have been no studies examining HIV-associated outcomes with respect to both sex and HCV status over time.…”

Factors Associated with Non-Adherence to Antiretroviral Therapy among Adults living with HIV/AIDS in Arsi Zone, Oromia

“…The regimens are often complicated and can include varying dosing schedules, dietary restrictions, and adverse effects [4].Consistently high levels of adherence are necessary for reliable viral suppression [5] and prevention of resistance [6], disease progression, and death [7]. Even though antiretroviral therapy is the single most dramatic development yet in the treatment of HIV/ AIDS, many have been described as inconsistent with their treatment regimens [8,9].…”

“…However, many studies reported that a number of patients took less than 95% of antiretroviral therapy [8,9]. A study done in southwest Ethiopia in 2008 found that the prevalence of non adherence to antiretroviral therapy was 21% [15].…”