title: Characterizing HIV medication adherence for virologic success among individuals living with HIV/AIDS: Experience with the CNS HIV Antiretroviral Therapy Effects Research (CHARTER) cohort.
abstract: Antiretroviral therapy (ART) has changed HIV related illness from terminal to chronic by suppressing viral load which results in immunologic and clinical improvement. Success with ART is dependent on optimal adherence, commonly categorized as >95%. As medication type, class and frequency of use continue to evolve, we assessed adherence levels related to viral suppression. Using a cross-sectional analysis with secondary data (n = 381) from an ongoing multi-site study on impact of ART on the Central Nervous System (CNS), we compared self-reported adherence rates with biological outcomes of HIV-RNA copies/ml, and CD4 cell/mm3. Adherence to ART measures included taking all prescribed medication as directed on schedule and following dietary restrictions. While depression was a barrier to adherence, undetectable viral suppression was achieved at pill adherence percentages lower than 95%. Practice, research and policy implications are discussed in the context of patient-, provider-, and system-level factors influencing adherence to ART.
authors.affiliation: School of Social Work, Eastern Washington University, Cheney, WA.
authors.forename: B
authors.initials: B
authors.lastname: Biswas
authors.affiliation: Department of Mathematics, Washington University in St. Louis, St. Louis, MO.
authors.forename: E
authors.initials: E
authors.lastname: Spitznagel
authors.affiliation: Department of Medicine, University of Washington, Seattle, WA.
authors.forename: A C
authors.initials: AC
authors.lastname: Collier
authors.affiliation: Department of Pathology, University of Texas Medical Branch, Galveston, TX.
authors.forename: B B
authors.initials: BB
authors.lastname: Gelman
authors.affiliation: Department of Neurology, Johns Hopkins University, Baltimore, MD.
authors.forename: J C
authors.initials: JC
authors.lastname: McArthur
authors.affiliation: Department of Pathology, Mount Sinai School of Medicine, New York, NY.
authors.forename: S
authors.initials: S
authors.lastname: Morgello
authors.affiliation: Department of Medicine, University of California, San Diego, La Jolla, CA.
authors.forename: J A
authors.initials: JA
authors.lastname: McCutchan
authors.affiliation: Department of Neurology, Washington University in St. Louis, St. Louis, MO.
authors.forename: D B
authors.initials: DB
authors.lastname: Clifford