Treatment simplification in HIV-infected adults as a strategy to prevent toxicity, improve adherence, quality of life and decrease healthcare costs

Nachega, Jean B.; Mugavero, Michael J.; Zeier, M; Vitória, Marco; Gallant, Joel E.

doi:10.2147/ppa.s22771

Cited by 80 publications

(69 citation statements)

References 61 publications

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“…Patients on QD regimens were significantly more adherent. Our observations indicate that ARV side effects and regimen improvements remain major reasons driving patient discontinuation of first-round therapy in the modern HAART era and are consistent with the findings of other groups [17][18][19]. The most common reasons for treatment switch or discontinuation were consistent over time and included change in regimen with the aim of improving the ARV regimen, gastrointestinal side effects, or neuropsychological complications.…”

Section: Discussionsupporting

confidence: 87%

“…These results suggest that treatment discontinuation in the modern-era of ARV and challenges to drug adherence remain key clinical issues [20][21][22][23]. Nevertheless, the benefits of less frequent treatment dosing was demonstrated in this analysis as QD patients were more adherent than BID+ patients, were more likely to achieve viral suppression, and less likely to discontinue or switch their initially prescribed regimen due to viral failure [18,[24][25][26][27][28][29]. These findings are highly relevant to informing clinicians in their attempts to retain patients on effective antiretroviral 4%) did not have dosing frequency recorded and were excluded **defined as <40 copies/mL (prior to 1998 assay sensitivity for suppression was <499 copies/mL) ***n's less than the total sample size reflect missing data therapy and are a critical component of the HIV cascade of care [30,31].…”

Section: Discussionmentioning

confidence: 73%

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Viral Suppression and Discontinuation Rates have Improved in HIV Patients with Modern Antiretroviral Therapies

Hamel¹,

Yu²,

Khan³

et al. 2017

J AIDS Clin Res

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Objective: Rates and determinants of first-line antiretroviral (ARV) discontinuation or change in prescribed regimen were assessed between old (pre-2006) and modern (post-2006) era stratified by dosing frequency [(once daily (QD) versus twice or more daily (BID+)].Methods: A single-center retrospective cohort study was conducted. All adult HIV patients initiating ARVs from January 1995-November 2015 were included. Patients were stratified by old-or modern-era and by dosing frequency. The primary outcome was rate of ARV therapy discontinuation or change in initial regimen. The secondary outcome was reason for discontinuation.Results: 1,127 patients were included from the old (n=621) and modern era (n=506). Modern-era patients were more likely to receive QD regimens (p<0.001) and had increased viral suppression at the last recorded testing than oldera patients (70.9% vs. 43.2%, p<0.001). Modern-era and QD patients had better adherence and treatment duration. Patients on integrase inhibitor (INSTI)-and NNRTI-based therapy had longer treatment durations and better ARV adherence. Risk factors for treatment switch or discontinuation included old-era therapy, IDU and PI+NRTI treatment. Older ages and immigrants were less likely to discontinue therapy. Common reasons for treatment discontinuation included changing treatments to improve regimen profile, gastrointestinal side effects, and neuropsychological issues. Conclusion:In patients initiating first-line ARV, risk of discontinuation or regimen changes has diminished in the modern-era with QD, INSTI-or NNRTI-based regimens. More attention to high risk patients including IDU is advised in attempts to improve outcomes. These findings provide 'real world' support for current clinical practice guidelines.

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Section: Discussionsupporting

confidence: 87%

Section: Discussionmentioning

confidence: 73%

Viral Suppression and Discontinuation Rates have Improved in HIV Patients with Modern Antiretroviral Therapies

Hamel¹,

Yu²,

Khan³

et al. 2017

J AIDS Clin Res

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“…[19][20] Decreasing pill burden by simplifying the ART regimen is one method used to promote ART adherence. 1,21 STRs that reduce pill burden to as little as 1 pill taken once daily have been associated with improved adherence, reduced hospitalizations, and improved viral suppression. [22][23][24][25][26] In our study, patients who received STRs were about 1.3 times more likely to be adherent (i.e., MPR ≥ 90%) than patients receiving more than 1 (N = 3,528) antiretroviral product.…”

Section: ■■ Discussionmentioning

confidence: 99%

Adherence to Antiretroviral Therapy in Managed Care Members in the United States: A Retrospective Claims Analysis

Cooke¹,

Lee²,

Xing³

2014

JMCP

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“…Anti Retro Virus (ARV) has been proven effective to increase CD4 levels, suppress HIV viral load and improve patients' quality of life (Nachega;Mugavero;Zeier;Vitória, Gallant, 2011). From this research, ARV resulting a decrease in the morbidity and mortality of HIV/AIDS patients.…”

Section: Introductionmentioning

confidence: 99%

Lost to Follow-Up : Reasons and True Outcome for Patients on Arv Treatment in Teratai Clinic Bandung Indonesia

Haroen¹,

Puspitasari²,

Borne³

et al. 2017

JPKI

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Klinik RSHS Teratai HIV telah merawat pasien dari September 2004 sampai Desember 2009, sebanyak 2.060 ODHA dan 1290 menerima ARV (63%). Selama periode ini, sebesar 11% (141 orang) kehilangan kontak lebih tinggi dari keseluruhan persentase di Indonesia yaitu 10,7% (Depkes, 2009). Tujuan dari penelitian ini adalah untuk menyelidiki hasil yang benar dan faktor hilang tindak lanjut ARV di klinik RSHS Teratai ARV. Penelitian ini menggunakan metode wawancara mendalam dengan 25 pasien HIV / AIDS bawah pengobatan ARV di klinik Teratai RSHS dan mangkir sejak tahun 2009 yang tinggal di daerah Bandung. Informan dipilih secara acak dan dihubungi untuk kunjungan rumah untuk diwawancarai oleh pewawancara yang berpengalaman. Peneliti melakukan wawancara mendalam di rumah pasien sekitar 60 menit. Data direkam oleh pita digital direkam, ditranskrip dan dicetak oleh dua peneliti bidang independen menggunakan analisis tematik.Hasil penelitian ini menunjukkan tujuh tema yang pengetahuan yang tidak benar, optimisme yang tidak realistis, masalah aadministratif, perasaan efek samping negatif, masalah interpersonal, masalah kecanduan, dan kurangnya perawatan diri. Oleh karena itu, penting untuk mengembangkan tindakan pencegahan melalui rincian kontak pasien, meminta pasien persetujuan untuk dihubungi, telepon, kunjungan rumah setelah 3 minggu kehilangan kontak, dan menyarankan pasien untuk mendaftar ke klinik ART lebih dekat dengan rumah mereka , dan mengembangkan sistem reminder untuk mengingatkan pasien untuk mengambil ARV tepat waktu. ABSTRACTTeratai clinic HIV RSHS has treated patients from September 2004 to December 2009, as much as 2060 PLWHA and 1290 receive ARV (63%). Over this period, 11% (141) were lost to follow-up that is higher than overall lost to follow up percentage in Indonesia which is 10.7% (MOH annually report December 2009). The aim of this study was to investigate the true outcomes and factors of lost follow up to ARV. This study used indepth interview method to 25 HIV/AIDS patients under ARV treatment in the Teratai clinic RSHS and lost to follow up since 2009 who lived in Bandung area. Informants were randomly selected and contacted for a home visit to be interviewed by experienced interviewer. The interviewers obtained verbal informed consent and conducted an in depth interview in the patients home. Interview took about 60 minutes. Data were recorded by digital tape recorded, transcribed and scored by two field researchers independently using thematic analysis. The result of this study shows seven themes which are incorrect knowledge, unrealistic optimism, administrative problems, feeling of negative side effect, interpersonal problem, addiction problem, and lack of self-care. Therefore, it is important to develop preventive measure through up-dating patients’ contact details, ask patients consent to be contacted, up date phone contact, home visit after 3 weeks lost of contact, advice patients to register to ART clinic closer to their homes, and develop a reminding system to remind patients to take ARV on time.

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Treatment simplification in HIV-infected adults as a strategy to prevent toxicity, improve adherence, quality of life and decrease healthcare costs

Cited by 80 publications

References 61 publications

Viral Suppression and Discontinuation Rates have Improved in HIV Patients with Modern Antiretroviral Therapies

Viral Suppression and Discontinuation Rates have Improved in HIV Patients with Modern Antiretroviral Therapies

Adherence to Antiretroviral Therapy in Managed Care Members in the United States: A Retrospective Claims Analysis

Lost to Follow-Up : Reasons and True Outcome for Patients on Arv Treatment in Teratai Clinic Bandung Indonesia

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