title: Impact of different patterns of nonadherence on the outcome of highly active antiretroviral therapy in patients with long-term follow-up.
abstract: OBJECTIVE
  The aim of the study was to evaluate the impact of different patterns of nonadherence on treatment outcomes in patients with long-term follow-up.
  
  
  METHODS
  This cohort study included patients who began highly active antiretroviral therapy during 1996-1999, with the last follow-up in 2007. Adherence was evaluated every 2 months by monitoring of pharmacy refills and by using self-reports. Patients were considered nonadherent at a specific visit when less than 90% of the prescribed drugs had been taken. Adherence was categorized as follows. (A) Continuous adherence: a patient had to be adherent in all of the evaluations throughout the period of follow-up. (B) Treatment interruption: drugs were not taken for more than 3 days, for any reason. Treatment failure was defined as viral load >500 HIV-1 RNA copies/mL or death. Cox proportional risk models were used to calculate adjusted relative hazards (ARHs) of treatment failure.
  
  
  RESULTS
  A total of 540 patients were included in the study, with a median follow-up of 8.3 years. Only 32.78% of patients achieved and maintained continuous adherence, and 42.78% of patients had treatment interruptions. Noncontinuous adherence [ARH 1.48; 95% confidence interval (CI) 1.02-2.14] and treatment interruptions (ARH 1.39; 95% CI 1.04-1.85) were associated with treatment failure for the overall cohort; however, for patients with more than 3 years of follow-up, only treatment interruptions were independently associated with treatment failure.
  
  
  CONCLUSIONS
  Only one-third of patients managed to achieve continuous adherence, and almost half of the patients had treatment interruptions, which have a particularly marked effect on treatment outcomes over the long term.
authors.affiliation: Department of Internal Medicine - Infectious Disease, Hospital del Mar, Barcelona, Paseo Marítimo 25-29, Barcelona 08003, Spain. hknobel@telefonica.net
authors.forename: H
authors.initials: H
authors.lastname: Knobel
authors.forename: O
authors.initials: O
authors.lastname: Urbina
authors.forename: A
authors.initials: A
authors.lastname: González
authors.forename: M L
authors.initials: ML
authors.lastname: Sorlí
authors.forename: M
authors.initials: M
authors.lastname: Montero
authors.forename: A
authors.initials: A
authors.lastname: Carmona
authors.forename: A
authors.initials: A
authors.lastname: Guelar
mesh_terms: D000328:Adult; D019380:Anti-HIV Agents / Q000627:therapeutic use*; D023241:Antiretroviral Therapy, Highly Active; D005260:Female; D015658:HIV Infections / Q000188:drug therapy* / Q000453:epidemiology; D015497:HIV-1; D006801:Humans; D008297:Male; D012307:Risk Factors; D013030:Spain / Q000453:epidemiology; D017211:Treatment Failure; D019562:Viral Load; D016903:Drug Monitoring
chemical_list: D019380:Anti-HIV Agents