Limited patient adherence to highly active antiretroviral therapy for HIV-1 infection in an observational cohort study.
BACKGROUND
Adherence to highly active antiretroviral therapy (HAART) for human immunodeficiency syndrome type 1 (HIV-1) infection is essential to sustain viral suppression and prevent drug resistance. We investigated adherence to HAART among patients in a clinical cohort study.


METHODS
Patients receiving HAART had their plasma concentrations of protease inhibitors or nevirapine measured and completed a questionnaire on adherence. We determined the percentage of patients who reported taking all antiretroviral medication on time and according to dietary instructions in the past week. Drug exposure was compared between patients reporting deviation from their regimen and fully adherent patients. Among patients who received HAART for at least 24 weeks, we assessed the association between adherence and virologic outcome.


RESULTS
A total of 224 of 261 eligible patients completed a questionnaire. Forty-seven percent reported taking all antiretroviral medication on time and according to dietary instructions. Patients who reported deviation from their regimen showed lower drug exposure compared with fully adherent patients (median concentration ratio, 0.81 vs 1.07; P =.001). Among those receiving HAART for at least 24 weeks, patients reporting deviation from their regimen were less likely to have plasma HIV-1 RNA levels below 500 copies/mL (adjusted odds ratio, 4.0; 95% confidence interval, 1.4-11.6) compared with fully adherent patients.


CONCLUSIONS
Only half of the patients took all antiretroviral medication in accordance with time and dietary instructions in the preceding week. Deviation from the antiretroviral regimen was associated with decreased drug exposure and a decreased likelihood of having suppressed plasma HIV-1 RNA loads. Patient adherence should remain a prime concern in the management of HIV-1 infection.
Nieuwkerk
P T
PT
Department of Medical Psychology (J4-410), Academic Medical Center, PO Box 22700, 1100 DE Amsterdam, the Netherlands. p.t.nieuwkerk@amc.uva.nl
Sprangers
M A
MA
Burger
D M
DM
Hoetelmans
R M
RM
Hugen
P W
PW
Danner
S A
SA
van Der Ende
M E
ME
Schneider
M M
MM
Schrey
G
G
Meenhorst
P L
PL
Sprenger
H G
HG
Kauffmann
R H
RH
Jambroes
M
M
Chesney
M A
MA
de Wolf
F
F
Lange
J M
JM
D000163:Acquired Immunodeficiency Syndrome / Q000097:blood / Q000188:drug therapy*; D000328:Adult; D019380:Anti-HIV Agents / Q000008:administration & dosage* / Q000097:blood; D015331:Cohort Studies; D004334:Drug Administration Schedule; D005260:Female; D017320:HIV Protease Inhibitors / Q000008:administration & dosage; D015497:HIV-1 / Q000187:drug effects* / Q000235:genetics; D006801:Humans; D019469:Indinavir / Q000008:administration & dosage; D008297:Male; D008875:Middle Aged; D019888:Nelfinavir / Q000008:administration & dosage; D019829:Nevirapine / Q000008:administration & dosage; D016017:Odds Ratio; D010349:Patient Compliance / Q000706:statistics & numerical data*; D012367:RNA, Viral / Q000187:drug effects; D018894:Reverse Transcriptase Inhibitors / Q000008:administration & dosage; D019438:Ritonavir / Q000008:administration & dosage; D019258:Saquinavir / Q000008:administration & dosage; D011795:Surveys and Questionnaires
D019380:Anti-HIV Agents; D017320:HIV Protease Inhibitors; D012367:RNA, Viral; D018894:Reverse Transcriptase Inhibitors; D019469:Indinavir; D019829:Nevirapine; D019888:Nelfinavir; D019258:Saquinavir; D019438:Ritonavir