Predictors of primary non-adherence to concomitant chronic treatment in HIV-infected patients with antiretroviral therapy

Abstract

ObjectivesTo identify the independent risk factors of primary non-adherence to chronic concomitant treatment in HIV-positive patients, and to measure primary and secondary non-adherence rates to chronic treatments, and secondary non-adherence to antiretroviral therapy and the prevalence of concomitant chronic diseases.MethodsWe conducted a retrospective study that included HIV-infected patients with antiretroviral treatmentwho attended the pharmaceutical care office between January and December 2012. The dependent variable was primary non-adherence to concomitant prescription drugs for chronic diseases. To know the predictors of concomitant primary non-adherence, we performed a univariate analysis and a multivariate binary logistic regression model to identify the independent predictors of primary non-adherence to co-medication.ResultsOut of 598 patients analysed, 333 patients had a new co-medication prescribed during the studied period. The number of comorbidities per patient was 2.3 and the patients were treated with an average of 3.4 drugs. The rates of primary and secondary non-adherence to co-medication were 8.4% and 44.4%, respectively. The co-occurrence of primary and secondary non-adherence was 24.9%. The number of comorbidities (p=0.001) and co-medications (p=0.001) was significantly higher in patients who had primary non-adherence to co-medication. Furthermore, there was a statistically significant relationship between primary non-adherence and patients treated with psychotropic drugs (p=0.03). The multivariate analysis showed the independent predictor of primary non-adherence to co-medication was the number of co-medications (p<0.001).ConclusionOne-third of new concomitant medications prescribed to HIV-positive patients were never filled from the pharmacy. The number of co-medications was identified as a predictor of primary non-adherence to chronic concomitant treatment in HIV-infected population.

Evaluation of the Sociodemographic, Behavioral and Clinical Influences on Complete Antiretroviral Therapy Adherence Among HIV-Infected Adults Receiving Medical Care in Houston, Texas

“…Further, as the number of PLWH with polypharmacy increased due to longer survival, comorbidity and co-medication are additional resultant barriers of poor adherence. [45][46][47][48] Though antiretroviral regimen complexity and pill burden were not directly evaluated in this study, we observed lower overall combined adherence when compared to adherence evaluated as medication dose, schedule, and instruction adherence separately. This finding suggested poorer antiretroviral adherence in PLWH, and supports previous reports that estimating adherence based on medication dose alone may overestimate the true adherence level.…”

Prevalence of Polypharmacy and Association to Pharmacotherapy Complexity in Older HIV-Positive Patients. The Sevihlla Study

“…This suggests prioritization of drug intake by patients based on their beliefs and perceptions about drugs 34 . The results of the Borrego et al 35 study showed that adherence problems begin at the time of prescription, because one third of patients will not even collect the prescribed medication.…”

Barriers and facilitators to maintaining a high level of polypharmacy adherence in people living with HIV: A scoping review

“…The influence of comorbidities on polypharmacy adherence lies mainly in the number, type, and severity of comorbidities (Krentz and Gill, 2016;Borrego et al, 2018;Manzano-García et al, 2018;Gimeno-Gracia and Sanchez-Rubio-Ferrandez, 2020). Most studies showed that comorbidities could lead to a decrease in adherence to one or more medications, especially for patients with psychiatric disorders (Walkup et al, 2008;Kumar and Encinosa, 2009).…”