Correlation between self-reported adherence to highly active antiretroviral therapy (HAART) and virologic outcome.
The Patient Medication Adherence Questionnaire Version 1.0 (PMAQ-V1.0) is a patient-reported adherence instrument to assess medication-taking behaviors and identify barriers to adherence with antiretroviral therapy. To assess the correlation between adherence and virologic outcome, the PMAQ-V1.0 was administered to 194 antiretroviral-experienced adults with HIV infection enrolled in a 16-week evaluation of protease inhibitor-containing regimens featuring a lamivudine/zidovudine combination tablet. At baseline, plasma HIV-1 RNA levels were less than 10,000 copies/mL and CD4(+)-cell counts were equal to or greater than 300 x 10(6)/L; patients had been receiving a conventional regimen of lamivudine + zidovudine (separately) plus a protease inhibitor for at least 10 weeks immediately prior to the study. Forty-eight percent of patients who reported missing at least one dose of a nucleoside reverse-transcriptase inhibitor (NRTI) during the study had detectable plasma HIV-1 RNA, compared with 26% of patients who reported no missed doses (P = .002). Patients who missed at least one dose of an NRTI or protease inhibitor were 2.5 times more likely to have quantifiable HIV-1 RNA than those who reported no missed doses. Patients who reported fewer barriers and more motivators to adherence had better virologic outcomes (P = .001). Several dimensions of the PMAQ-V1.0 did not function as well as hypothesized. In this study, self-reported adherence derived from the PMAQ-V1.0 predicted virologic outcomes, but further refinement of the dimensions appears warranted.
DeMasi
R A
RA
Glaxo Wellcome Inc., Research Triangle Park, North Carolina, USA.
Graham
N M
NM
Tolson
J M
JM
Pham
S V
SV
Capuano
G A
GA
Fisher
R L
RL
Shaefer
M S
MS
Pakes
G E
GE
Sawyerr
G A
GA
Eron
J J
JJ
D015492:AIDS Serodiagnosis; D000293:Adolescent; D000328:Adult; D019380:Anti-HIV Agents / Q000008:administration & dosage*; D004334:Drug Administration Schedule; D004338:Drug Combinations; D005260:Female; D015658:HIV Infections / Q000175:diagnosis* / Q000188:drug therapy*; D015497:HIV-1 / Q000302:isolation & purification*; D006801:Humans; D019259:Lamivudine / Q000008:administration & dosage; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D010349:Patient Compliance / Q000706:statistics & numerical data*; D010358:Patient Participation; D011446:Prospective Studies; D012367:RNA, Viral / Q000032:analysis*; D011795:Surveys and Questionnaires; D016312:Treatment Refusal / Q000706:statistics & numerical data*; D019562:Viral Load; D015215:Zidovudine / Q000008:administration & dosage
D019380:Anti-HIV Agents; D004338:Drug Combinations; D012367:RNA, Viral; D019259:Lamivudine; D015215:Zidovudine