Sociodemographic factors predict early discontinuation of HIV non-nucleoside reverse transcriptase inhibitors and protease inhibitors.
OBJECTIVE
HIV infection has a devastating impact on individual and public health, and affects populations disproportionately. Treatment with antiretroviral therapy (ART) saves lives, but long-term adherence to ART is critical to its success. We performed an observational cohort study to determine the influence of race, sex and other sociodemographic factors on early ART discontinuations among HIV-infected persons.


METHODS
TennCare-enrolled adults of black or white non-Hispanic race beginning ART with either a non-nucleoside reverse transcriptase inhibitor (NNRTI) or protease inhibitor (PI) between 1996-2003 (N=3654) were assessed for early discontinuation. A subgroup of discontinuations was validated using the primary medical record.


RESULTS
Blacks were more likely than whites to discontinue NNRTIs (37 vs. 28%; P=0.003) and PIs (36 vs. 25%; P < or = 0.001). In multivariable models adjusting for race, sex, age, early HIV-related medical encounter, urban residence and TennCare enrollment category, black race, female sex and younger age were independent predictors of discontinuation among those starting PIs. Among persons starting NNRTIs, black race, younger age and a disability-based enrollment category predicted early drug discontinuation, but female sex did not.


CONCLUSIONS
Our results suggest that sociodemographic factors were associated with early NNRTI and PI discontinuation in this population, and some factors were ART class specific.
Asad
Shaheena
S
Department of Internal Medicine, Divisions of Hematology Oncology, University School of Medicine, Nashville, TN, USA.
Hulgan
Todd
T
Raffanti
Stephen P
SP
Daugherty
Jim
J
Ray
Wayne
W
Sterling
Timothy R
TR
D000293:Adolescent; D000328:Adult; D001741:Black or African American / Q000706:statistics & numerical data; D000368:Aged; D044966:Anti-Retroviral Agents / Q000627:therapeutic use*; D005260:Female; D015658:HIV Infections / Q000188:drug therapy*; D006801:Humans; D016015:Logistic Models; D008297:Male; D055118:Medication Adherence; D008875:Middle Aged; D011480:Protease Inhibitors / Q000627:therapeutic use; D018894:Reverse Transcriptase Inhibitors / Q000627:therapeutic use; D012959:Socioeconomic Factors; D013714:Tennessee; D044465:White People / Q000706:statistics & numerical data; D055815:Young Adult
D044966:Anti-Retroviral Agents; D011480:Protease Inhibitors; D018894:Reverse Transcriptase Inhibitors