title: Adherence, virological and immunological outcomes for HIV-infected veterans starting combination antiretroviral therapies.
abstract: OBJECTIVE
  We aimed to determine adherence, virological, and immunological outcomes one year after starting a first combination antiretroviral therapy (ART) regimen.
  
  
  METHODS
  Observational; synthesis of administrative, laboratory, and pharmacy data. Antiretroviral regimens were divided into efavirenz, nevirapine, boosted protease inhibitor (PI), and single PI categories. Propensity scores were used to control for confounding by treatment assignment. Adherence was estimated from pharmacy refill records.
  
  
  METHODS
  Veterans Affairs Healthcare System, all sites.
  
  
  METHODS
  HIV-infected individuals starting combination ART with a low likelihood of previous antiretroviral exposure.
  
  
  METHODS
  None.
  
  
  RESULTS
  The proportion of antiretroviral prescriptions filled as prescribed, a change in log HIV-RNA, the proportion with log HIV-RNA viral suppression, a change in CD4 cell count.
  
  
  RESULTS
  A total of 6394 individuals unlikely to have previous antiretroviral exposure started combination ART between 1996 and 2004, and were eligible for analysis. Adherence overall was low (63% of prescriptions filled as prescribed), and adherence with efavirenz (67%) and nevirapine (65%) regimens was significantly greater than adherence with boosted PI (59%) or single PI (61%) regimens (P < 0.001). Efavirenz regimens were more likely to suppress HIV-RNA at one year (74%) compared with nevirapine (62%), boosted PI (63%), or single PI (53%) regimens (all P < 0.001), and this superiority was maintained when analyses were adjusted for baseline clinical characteristics and propensity for treatment assignment. Efavirenz also yielded more favorable immunological outcomes.
  
  
  CONCLUSIONS
  HIV-infected individuals initiating their first combination ART using an efavirenz-based regimen had improved virological and immunological outcomes and greater adherence levels.
authors.affiliation: Section of General Internal Medicine, Department of Medicine, Yale University, 950 Campbell Avenue, West Haven, CT 06516, USA. Ronald.Braithwaite@va.gov
authors.forename: R Scott
authors.initials: RS
authors.lastname: Braithwaite
authors.forename: Michael J
authors.initials: MJ
authors.lastname: Kozal
authors.forename: Chung Chou H
authors.initials: CC
authors.lastname: Chang
authors.forename: Mark S
authors.initials: MS
authors.lastname: Roberts
authors.forename: Shawn L
authors.initials: SL
authors.lastname: Fultz
authors.forename: Matthew Bidwell
authors.initials: MB
authors.lastname: Goetz
authors.forename: Cynthia
authors.initials: C
authors.lastname: Gibert
authors.forename: Maria
authors.initials: M
authors.lastname: Rodriguez-Barradas
authors.forename: Larry
authors.initials: L
authors.lastname: Mole
authors.forename: Amy C
authors.initials: AC
authors.lastname: Justice
mesh_terms: D000328:Adult; D000480:Alkynes; D019380:Anti-HIV Agents / Q000008:administration & dosage* / Q000627:therapeutic use; D023241:Antiretroviral Therapy, Highly Active / Q000379:methods / Q000523:psychology; D048588:Benzoxazines / Q000008:administration & dosage / Q000627:therapeutic use; D018791:CD4 Lymphocyte Count; D015331:Cohort Studies; D003521:Cyclopropanes; D004334:Drug Administration Schedule; D005260:Female; D015658:HIV Infections / Q000188:drug therapy* / Q000276:immunology / Q000523:psychology / Q000821:virology; D015497:HIV-1 / Q000302:isolation & purification; D006801:Humans; D008297:Male; D008875:Middle Aged; D010349:Patient Compliance; D012367:RNA, Viral / Q000097:blood; D018894:Reverse Transcriptase Inhibitors / Q000008:administration & dosage / Q000627:therapeutic use; D016896:Treatment Outcome; D014728:Veterans / Q000706:statistics & numerical data; D019562:Viral Load
chemical_list: D000480:Alkynes; D019380:Anti-HIV Agents; D048588:Benzoxazines; D003521:Cyclopropanes; D012367:RNA, Viral; D018894:Reverse Transcriptase Inhibitors; C098320:efavirenz