title: Adherence and persistence with non-nucleoside reverse transcriptase inhibitor-based antiretroviral regimens.
abstract: OBJECTIVE
  The objective of this study was to examine adherence and persistency in HIV patients initiating first-line combination antiretroviral therapy (cART) with a non-nucleoside reverse transcriptase inhibitor (NNRTI)-based regimen.
  
  
  METHODS
  Using US health insurance records, the authors identified all persons aged ≥ 18 years with HIV, who began NNRTI-based cART between 1 January 2003 and 30 September 2009. They examined adherence using proportion of days covered (PDC), and non-persistency based on evidence of discontinuation, switching or augmentation. Differences in non-adherence (1 - PC) and non-persistency were compared over 12 months, between three treatment groups: i) efavirenz, emtricitabine and tenofovir as a fixed-dose combination ('EFV/FTC/TDF'); ii) EFV-based regimens other than EFV/TDF/FTC, with ≥ 2 NRTIs ('EFV + ≥ 2 NRTIs'); and iii) nevirapine-based regimens with ≥ 2 NRTIs (NVP + ≥ 2 NRTIs).
  
  
  RESULTS
  There were 1874 patients receiving EFV/FTC/TDF, 893 receiving EFV + ≥ 2 NRTIs and 207 receiving NVP + ≥ 2 NRTIs. Adherence was lower for both EFV + ≥ 2 NRTIs and NVP + ≥ 2 NRTIs than for EFV/FTC/TDF (rate ratio (RR) = 1.57 and 2.01, respectively; both p < 0.01), while non-persistency was higher (hazard ratio (HR) = 1.56, p < 0.01 and 1.70, p < 0.01, respectively).
  
  
  CONCLUSIONS
  Adherence and persistency may differ between NNRTI-based regimens; additional analyses are needed to understand the reasons for these differences.
authors.affiliation: Policy Analysis, Inc., Brookline, MA, USA.
authors.forename: Charu
authors.initials: C
authors.lastname: Taneja
authors.forename: Timothy
authors.initials: T
authors.lastname: Juday
authors.forename: Larry
authors.initials: L
authors.lastname: Gertzog
authors.forename: John
authors.initials: J
authors.lastname: Edelsberg
authors.forename: Todd
authors.initials: T
authors.lastname: Correll
authors.forename: Tony
authors.initials: T
authors.lastname: Hebden
authors.forename: Gerry
authors.initials: G
authors.lastname: Oster
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D019380:Anti-HIV Agents / Q000008:administration & dosage*; D023241:Antiretroviral Therapy, Highly Active / Q000706:statistics & numerical data; D005260:Female; D015658:HIV Infections / Q000188:drug therapy; D006801:Humans; D008297:Male; D055118:Medication Adherence; D008875:Middle Aged; D012044:Regression Analysis; D018894:Reverse Transcriptase Inhibitors / Q000008:administration & dosage*; D055815:Young Adult
chemical_list: D019380:Anti-HIV Agents; D018894:Reverse Transcriptase Inhibitors