Variations in Patterns of Highly Active Antiretroviral Therapy (HAART) Adherence

Abstract

Strict adherence to highly active antiretroviral therapy (HAART) is necessary for successful suppression of HIV replication. A large number of individuals are not adherent, however, and the reasons for non-adherence are varied and complex. We utilized cluster analyses to identify subgroups of adherers in a sample of 222 HIV positive individuals whose HAART use was electronically monitored. Five distinct subgroups were identified, with characteristic variations across the week and over the course of the 4-week study. Additional comparisons of demographic and behavioral variables found the worst adherers to have higher rates of substance use, and that a group with higher rates of cognitive impairment had a consistent drop in adherence during the weekends. In addition, the group with the best adherence had more individuals over the age of 50 years. The results of the current study indicate that distinct subgroups of adherers may exist, and suggest that interventions designed to improve adherence can be designed to accommodate this variability in behavior.

Performance of a World Health Organization first‐line regimen (stavudine/lamivudine/nevirapine) in antiretroviral‐naïve individuals in a Western setting

“…These findings were similar to those of studies [6,7] conducted in resourcelimited settings. Adherence, injecting drug use, and baseline pVL were associated with time to viral load suppression in multivariate analysis; these observations have also been previously reported [6,[8][9][10][11][12][13]. These data indicate that this regimen should be expected to lead to successful virological suppression in most settings, and, if this is not the case, it may indicate serious flaws with the implementation of antiviral programmes.…”

Antiretroviral Adherence and the Nature of HIV-Associated Verbal Memory Impairment

“…13,16–19 Although the current cognitive impairment-profile of HIV is relatively mild for many individuals, it is nonetheless predictive of significant decline in daily functioning. 20 Also, significant variability in HAART adherence patterns among HIV+ individuals 21 may account for recent reports of variable neurocognitive expression of HIV. 15 …”

Cognitive behavioral therapy improves adherence to antiretroviral therapy in HIV-infected patients: a prospective randomized controlled trial from eastern India

“…It was also noted that the subgroup with a higher degree of cognitive impairment had a consistent drop in the adherence level. These results suggest that there are distinct subgroups of adherers with different behavioral features and interventions are to be designed accordingly to accommodate this variability in behavior [24]. Johnson et al studied the effect of CBT on adherence in 204 HIV-infected patients with self-reported adherence < 85% at baseline and followed them up for up to 25 months.…”