Patterns of antiretroviral therapy adherence and impact on HIV RNA among patients in North America.

TitlePatterns of antiretroviral therapy adherence and impact on HIV RNA among patients in North America.
Publication TypeJournal Article
Year of Publication2012
AuthorsGenberg BL, Wilson IB, Bangsberg DR, Arnsten J, Goggin K, Remien RH, Simoni J, Gross R, Reynolds N, Rosen M, Liu H
Corporate AuthorsMACH14 Investigators
JournalAIDS
Volume26
Issue11
Pagination1415-23
Date Published2012 Jul 17
ISSN1473-5571
KeywordsAcquired Immunodeficiency Syndrome, Adult, Anti-HIV Agents, Drug Monitoring, Female, Humans, Logistic Models, Longitudinal Studies, Male, Medication Adherence, Middle Aged, North America, RNA, Viral, Treatment Outcome
Abstract

OBJECTIVE: Adherence to antiretroviral therapies (ART) is the strongest predictor of viral suppression among individuals infected with HIV, however, limited data exists to understand the patterns of adherence that confer the greatest benefit across different ART regimens.

DESIGN: Longitudinal data pooled from 16 studies conducted between 1997 and 2009 across the United States.

METHODS: Adherence was measured using Medication Event Monitoring System. Percentage of time with sufficient drug concentrations (covered time) and the length of the longest treatment interruption during the 28 days prior to plasma HIV-RNA measurements were calculated. Logistic regression with generalized estimating equations was used to estimate medication-specific adherence estimates on detectable HIV-RNA (>400 copies/ml).

RESULTS: One thousand and eighty-eight participants with 3795 HIV-RNA measures were studied. Both lower covered time and greater longest interruption showed dose-response relationships with the odds of detectable HIV-RNA; however, estimates did not vary by medication regimen. Compared with 93-100% coverage, periods of 0-25% covered time had a three-fold increased risk of detectable HIV-RNA [odds ratio (OR) = 3.22, 95% confidence interval (CI): 2.48-4.19]. Similarly, compared to longest interruptions of 0-48 h, longest interruptions of 21-28 days had a nearly four-fold increased risk of detectable HIV-RNA (OR = 3.65, 95% CI: 2.77, 4.81).

CONCLUSION: We found that adherence was consistently strongly associated with treatment response across ART regimens. Of the patterns of adherence, longer interruptions may have greater impact than covered time. Future research should investigate additional methods for examining adherence patterns, understanding the determinants of consecutive missed doses and the evaluation of interventions designed to address interruptions in treatment.

DOI10.1097/QAD.0b013e328354bed6
Alternate JournalAIDS
PubMed ID22767342
PubMed Central IDPMC3655551
Grant ListAI069419 / AI / NIAID NIH HHS / United States
AI38858 / AI / NIAID NIH HHS / United States
K02 DA017277 / DA / NIDA NIH HHS / United States
K02DA017277 / DA / NIDA NIH HHS / United States
K08 MH001584 / MH / NIMH NIH HHS / United States
K23 MH001862 / MH / NIMH NIH HHS / United States
K23MH01862 / MH / NIMH NIH HHS / United States
K24 HD069204 / HD / NICHD NIH HHS / United States
K24 MH087227 / MH / NIMH NIH HHS / United States
K24 MH092242 / MH / NIMH NIH HHS / United States
P01 MH049548 / MH / NIMH NIH HHS / United States
P01MH49548 / MH / NIMH NIH HHS / United States
P30 AI050410 / AI / NIAID NIH HHS / United States
P30 MH043520 / MH / NIMH NIH HHS / United States
R01 DA011869 / DA / NIDA NIH HHS / United States
R01 DA015215 / DA / NIDA NIH HHS / United States
R01 DA015679 / DA / NIDA NIH HHS / United States
R01 MH054907 / MH / NIMH NIH HHS / United States
R01 MH058986 / MH / NIMH NIH HHS / United States
R01 MH061173 / MH / NIMH NIH HHS / United States
R01 MH068197 / MH / NIMH NIH HHS / United States
R01 MH078773 / MH / NIMH NIH HHS / United States
R01 NR004749 / NR / NINR NIH HHS / United States
R01AI41413 / AI / NIAID NIH HHS / United States
R01DA015679 / DA / NIDA NIH HHS / United States
R01DA11869 / DA / NIDA NIH HHS / United States
R01DA13826 / DA / NIDA NIH HHS / United States
R01DA15215 / DA / NIDA NIH HHS / United States
R01MH01584 / MH / NIMH NIH HHS / United States
R01MH078773 / MH / NIMH NIH HHS / United States
R01MH54907 / MH / NIMH NIH HHS / United States
R01MH58986 / MH / NIMH NIH HHS / United States
R01MH61173 / MH / NIMH NIH HHS / United States
R01MH61695 / MH / NIMH NIH HHS / United States
R01MH68197 / MH / NIMH NIH HHS / United States
R01NR04749 / NR / NINR NIH HHS / United States
R25 DA023021 / DA / NIDA NIH HHS / United States
T32HS01965 / HS / AHRQ HHS / United States