title: Pharmacy-based assessment of adherence to HAART predicts virologic and immunologic treatment response and clinical progression to AIDS and death.
abstract: Although adherence to HAART at a level above 95% has been associated with optimal viral suppression, the impact of different levels of adherence on long-term clinical outcomes has not been determined. We used an objective pharmacy-based measure to examine the association between three levels of adherence to HAART and disease progression among a population-based cohort of HIV-infected patients attending an urban HIV specialty clinic. Higher levels of adherence to HAART were significantly associated with longer time to virologic failure (P < 0.001), greater increase in CD4 cell count (P = 0.04), and lower risk of progression to clinical AIDS or death (P < 0.007). After controlling for other factors, patients with low adherence had over five times the risk of disease progression than patients with moderate adherence (P = 0.007) or patients with high adherence (P = 0.001). There was no significant difference in the risk of progression between patients with moderate and high levels of adherence (P > 0.2). Patients who progressed to AIDS or death had significantly higher viral loads (P = 0.01) and lower CD4 cell counts (P = 0.03) than patients who experienced virologic failure, but did not progress.
authors.affiliation: Department of Medicine, University of Washington, Seattle, Washington 98104, USA. kitahata@u.washington.edu
authors.forename: Mari M
authors.initials: MM
authors.lastname: Kitahata
authors.forename: Shelby D
authors.initials: SD
authors.lastname: Reed
authors.forename: Peter W
authors.initials: PW
authors.lastname: Dillingham
authors.forename: Stephen E
authors.initials: SE
authors.lastname: Van Rompaey
authors.forename: Alicia A
authors.initials: AA
authors.lastname: Young
authors.forename: Robert D
authors.initials: RD
authors.lastname: Harrington
authors.forename: King K
authors.initials: KK
authors.lastname: Holmes
mesh_terms: D000328:Adult; D023241:Antiretroviral Therapy, Highly Active; D018791:CD4 Lymphocyte Count; D015331:Cohort Studies; D018450:Disease Progression; D016903:Drug Monitoring; D005260:Female; D015658:HIV Infections / Q000188:drug therapy / Q000276:immunology / Q000401:mortality / Q000821:virology; D006801:Humans; D008297:Male; D008875:Middle Aged; D010349:Patient Compliance; D010604:Pharmacy; D011237:Predictive Value of Tests; D012367:RNA, Viral / Q000097:blood; D016896:Treatment Outcome; D019562:Viral Load
chemical_list: D012367:RNA, Viral