title: Short-term discontinuation of HAART regimens more common in vulnerable patient populations.
abstract: The durability of HAART regimens is often limited by antiretroviral toxicity and nonadherence, which lead to virologic failure. We sought to determine sociodemographic and psychosocial patient factors predictive of short-term discontinuation of HAART regimens overall and stratified by the reason for discontinuation. A retrospective cohort study of the UAB 1917 Clinic Cohort evaluated short-term HAART regimen discontinuation (within 12 months of regimen initiation) between 1/1995 and 8/2004 classified as (1) gastrointestinal (GI) toxicity, (2) non-GI toxicity, (3) virologic failure or nonadherence (VF/NA), (4) loss to follow-up, and (5) other. Multivariable multinomial logistic regression models accounting for dependent observations were fit to assess the relationship between patient factors and type-specific regimen discontinuation. Among the 738 study participants, 1026 of 1852 HAART regimens (55%) were discontinued within 12 months of initiation. In multivariable analysis, discontinuation for GI toxicity was more common in patients lacking private health insurance and those with a history of intravenous (IV) drug use, whereas non-GI toxicity was more common in younger patients and females. African-American patients and those with a history of IV drug use were more likely to stop a regimen due to VF/NA. Loss to follow-up was more common in younger patients, individuals who were uninsured, and those with a history of IV drug use. Short-term discontinuation of HAART regimens is more common in vulnerable populations that bear a disproportionate burden of the U.S. HIV/AIDS epidemic. More vigilant monitoring of patient populations at higher risk of toxicity and virologic failure may allow for improved HAART regimen durability.
authors.affiliation: University of Alabama at Birmingham, Birmingham, Alabama 35294, USA.
authors.forename: Lindsay S
authors.initials: LS
authors.lastname: Robison
authors.forename: Andrew O
authors.initials: AO
authors.lastname: Westfall
authors.forename: Michael J
authors.initials: MJ
authors.lastname: Mugavero
authors.forename: Mirjam C
authors.initials: MC
authors.lastname: Kempf
authors.forename: Stephen R
authors.initials: SR
authors.lastname: Cole
authors.forename: Jeroan J
authors.initials: JJ
authors.lastname: Allison
authors.forename: James H
authors.initials: JH
authors.lastname: Willig
authors.forename: James L
authors.initials: JL
authors.lastname: Raper
authors.forename: C Mel
authors.initials: CM
authors.lastname: Wilcox
authors.forename: Michael S
authors.initials: MS
authors.lastname: Saag
mesh_terms: D000328:Adult; D000367:Age Factors; D023241:Antiretroviral Therapy, Highly Active; D015331:Cohort Studies; D005260:Female; D015658:HIV Infections / Q000188:drug therapy* / Q000453:epidemiology*; D006801:Humans; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D012189:Retrospective Studies; D012959:Socioeconomic Factors; D015819:Substance Abuse, Intravenous; D014481:United States / Q000453:epidemiology; D016903:Drug Monitoring