title: Limitations of a simplification antiretroviral strategy for HIV-infected patients with decreasing adherence to a protease inhibitor regimen.
abstract: OBJECTIVE
  To determine the long-term efficacy of a simplification strategy in the clinical setting when used to improve adherence.
  
  
  METHODS
  Prospective study of 70 patients included in a regimen with ddI plus 3TC plus an NNRTI, after viral suppression with a PI-containing regimen, due to decreasing adherence. Adherence to PI was calculated as the percentage of doses taken last week before inclusion, and patients were stratified as high and low adherence (95% and <95% of doses).
  
  
  RESULTS
  Overall, 19 patients (27%) related adherence to PI <95% at inclusion (6 patients [9%], with adherence <80%). Mean adherence improved, with only 8% of patients presenting values <95%. At 104 weeks, 88% of patients on therapy had viral load suppression, but only 43% by ITT analysis. The main cause of therapy change or withdrawal was toxicity or drug interactions (26%). Notably, 16% of patients were lost to follow-up or left therapy, especially in the group of initially low adherent (26% vs. 12%, p = .02).
  
  
  CONCLUSIONS
  The use of a simplification strategy could be associated with long-term high risk of treatment failure, when used to improve adherence in the clinical setting.
authors.affiliation: Departament of Infectious Diseases, Ramon y Cajal Hospital, Madrid, Spain. jmoyam.hrc@salud.madrid.org
authors.forename: J
authors.initials: J
authors.lastname: Moya
authors.forename: J L
authors.initials: JL
authors.lastname: Casado
authors.forename: L
authors.initials: L
authors.lastname: Aranzabal
authors.forename: A
authors.initials: A
authors.lastname: Moreno
authors.forename: A
authors.initials: A
authors.lastname: Antela
authors.forename: F
authors.initials: F
authors.lastname: Dronda
authors.forename: M J
authors.initials: MJ
authors.lastname: Perez-Elías
authors.forename: A
authors.initials: A
authors.lastname: Marin
authors.forename: S
authors.initials: S
authors.lastname: Moreno
mesh_terms: D000328:Adult; D019380:Anti-HIV Agents / Q000627:therapeutic use; D044966:Anti-Retroviral Agents / Q000627:therapeutic use* / Q000633:toxicity; D016049:Didanosine / Q000627:therapeutic use; D004347:Drug Interactions; D005260:Female; D015658:HIV Infections / Q000188:drug therapy*; D017320:HIV Protease Inhibitors / Q000627:therapeutic use* / Q000633:toxicity; D006801:Humans; D019259:Lamivudine / Q000627:therapeutic use; D008297:Male; D008875:Middle Aged; D010349:Patient Compliance; D011446:Prospective Studies; D012307:Risk Factors; D017211:Treatment Failure
chemical_list: D019380:Anti-HIV Agents; D044966:Anti-Retroviral Agents; D017320:HIV Protease Inhibitors; D019259:Lamivudine; D016049:Didanosine