The Consistency of Adherence to Antiretroviral Therapy Predicts Biologic Outcomes for Human Immunodeficiency Virus–Infected Persons in Clinical Trials

Mannheimer, Sharon; Friedland, Gerald; Matts, John P.; Child, Carroll; Chesney, Margaret A.

doi:10.1086/339074

Cited by 441 publications

(329 citation statements)

References 22 publications

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“…The lack of methodological standards makes assessments and comparisons between levels of 20 . However newer data with NNRTI-based regimens (which also likely apply to ritonavir-boosted, PI-based regimens) suggest that current antiretroviral regimens can tolerate some degree of imperfect adherence while maintaining the beneficial effects of HIV therapy in most patients 11 .…”

Section: Discussionmentioning

confidence: 99%

Risk-factors for non-adherence to antiretroviral therapy

Silva

Ximenes

Filho

et al. 2009

Rev. Inst. Med. trop. S. Paulo

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SUMMARYCross-sectional study analyzed as case-control to identify risk factors for non-adherence to antiretroviral therapy. We studied 412 out-clinics HIV infected subjects of three public hospitals of Recife, Pernambuco. The objective was to examine the association between non-adherence to the antiretroviral therapy and biological, social-behavior and demographics and economic factors, factors related to the disease and/or treatment, factors related to life habits and depression symptoms. Variables significantly associated with non-adherence to antiretroviral therapy were: time elapsed since HIV diagnosis (p = 0.002), daily dose (p = 0.046), use of alcohol (p = 0.030) and past drug use (p = 0.048), and borderline p-values were found for educational level (p = 0.093) and family monthly income (p = 0.08). In the multivariable analysis, the factors that remained in the final model were family monthly income, time period with HIV infection and use of alcohol. No association was observed between non-adherence to antiretroviral therapy and gender, age, sexual orientation, marital status, educational level and place of residence.Based on our results and the local situation we suggest: assessment of social needs; training of partners and/or families on supporting adherence, creation of "adherence groups" to motivate and to reassure patients on the benefits of treatment; counseling and/or psychotherapy for alcohol drinkers.

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Section: Discussionmentioning

confidence: 99%

Risk-factors for non-adherence to antiretroviral therapy

Silva

Ximenes

Filho

et al. 2009

Rev. Inst. Med. trop. S. Paulo

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“…Since most of the staff and all counselors are local people, some HIV-positive themselves, they are able to comprehend and discuss many problems that patients in the program encounter. Given that adherence is vital to good treatment outcomes [10,[33][34][35], we feel that the emphasis on counseling and adherence were essential for the program's success. However, even in this closely monitored, strictly counseled, and fully funded environment, with no monetary costs for the patient, over 15% of patients were lost to follow-up.…”

Section: Discussionmentioning

confidence: 99%

Effectiveness of highly active antiretroviral therapy administered by general practitioners in rural South Africa

Barth

Meer

Hoepelman

et al. 2008

Eur J Clin Microbiol Infect Dis

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The purpose of this study was to assess the oneyear efficacy of highly active antiretroviral therapy (HAART) administered by general practitioners in a primary care community clinic in rural South Africa. We performed an observational cohort study of 675 treatmentnaïve human immunodeficiency virus (HIV)-infected patients (including 66 children) who began HAART at least 12 months prior to the data analyses. Throughout treatment, the CD4+ T-cell count (percentage of CD4+ Tcells in children) and plasma HIV-RNA level were determined and the patient's weight was recorded. The primary outcome was mortality. Secondary outcomes were viral suppression, immunological response, and weight gain. One year after the start of HAART, 100 of the 675 (15%) patients were lost to follow-up and 119 patients (18%), including six children, died. Mortality was highest during the first few months of treatment. Based on an ontreatment analysis at one year after the start of therapy, 83% of adults and 71% of children had a viral load <400 copies/ ml; the viral load was <50 copies/ml in 70% of adults and 61% of children. At one year, the mean CD4+ T-cell count in adults had increased by 236/mm 3 , and the mean body mass index (BMI) had increased by 3.5 kg/m 2 . In children, the mean CD4% had increased by 17.6. A low Karnofsky score and a low baseline CD4+ T-cell count were independently associated with death. In addition to these factors, a low baseline BMI and gender were predictive of a poor immunological outcome. Our study shows that adequately monitored HIV/acquired immunodeficiency syndrome (AIDS) care administered by general practitioners and their staff is feasible and leads to good results in a rural, primary care center in sub-Saharan Africa. In order to achieve even better results, early mortality should be reduced and efforts should be made to start HAART earlier.

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“…Substantial variation also exists in the relevant time frame, with recall periods including the past one, three, seven, or thirty days (4). Response options may be Likert (6)(7)(8) or visual analog scales (9)(10)(11), and may be close-ended or open-ended. Some self-report measures consist of a single item, some are scales (12), and some questions assist the respondent with visual aids or anchors.…”

Section: Self-reportmentioning

confidence: 99%

Practical and Conceptual Challenges in Measuring Antiretroviral Adherence

Berg

Arnsten

2006

JAIDS Journal of Acquired Immune Deficiency Syndromes

260

264

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Accurate measurement of antiretroviral adherence is essential for targeting and rigorously evaluating interventions to improve adherence and prevent viral resistance. Across diseases, medication adherence is an individual, complex, and dynamic human behavior that presents unique measurement challenges. Measurement of medication adherence is further complicated by the diversity of available measures, which have different utility in clinical and research settings. Limited understanding of how to optimize existing adherence measures has hindered progress in adherence research in both HIV and other diseases. Though self-report is the most widely used adherence measure and the most promising for use in clinical care and resource limited settings, adherence researchers have yet to develop evidence-based standards for self-reported adherence. In addition, the use of objective measures, such as electronic drug monitoring or pill counts, is limited by poor understanding of the source and magnitude of error biasing these measures. To address these limitations, research is needed to evaluate methods of combining information from different measures. The goals of this review are to describe the state of the science of adherence measurement, to discuss the advantages and disadvantages of common adherence measurement methods, and to recommend directions for improving antiretroviral adherence measurement in research and clinical care.

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The Consistency of Adherence to Antiretroviral Therapy Predicts Biologic Outcomes for Human Immunodeficiency Virus–Infected Persons in Clinical Trials

Cited by 441 publications

References 22 publications

Risk-factors for non-adherence to antiretroviral therapy

Risk-factors for non-adherence to antiretroviral therapy

Effectiveness of highly active antiretroviral therapy administered by general practitioners in rural South Africa

Practical and Conceptual Challenges in Measuring Antiretroviral Adherence

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