title: The influence of patient beliefs and treatment satisfaction on the discontinuation of current first-line antiretroviral regimens.
abstract: OBJECTIVE
  Large cohort studies have shown a high rate of first-line combination antiretroviral therapy (cART) regimen discontinuation in HIV-infected patients, attributed to characteristics of the cART regimen or toxicity.
  
  
  METHODS
  A cohort study of 274 patients receiving a first-line regimen was carried out. Patients' perceptions and beliefs prior to initiation were assessed using an attitude towards medication scale (0-15 points), and their satisfaction during therapy was assessed using an HIV treatment satisfaction questionnaire (HIVTSQ). Treatment discontinuation was defined as any switch in the cART regimen.
  
  
  RESULTS
  During 474.8 person-years of follow-up, 63 (23%) patients changed their cART regimen, mainly because of toxicity/intolerance (42; 67%). The overall rate of change was 13.2 per 100 patient-years [95% confidence interval (CI) 11.1-16.4 per 100 patient-years]. An efavirenz (EFV)-based single tablet regimen showed the highest rate of adverse events (27%), but the lowest rate of change (16%; 7.44 per 100 patient-years). Cox regression revealed a decreased hazard of first regimen termination with better initial attitude towards drugs [hazard ratio (HR) 0.76; 95% CI 0.62-0.93; P < 0.01] and higher satisfaction (HR 0.94; 95% CI 0.89-0.99; P = 0.01), and an increased hazard of termination with the presence of adverse events (HR 7.7; 95% CI 2.4-11.6; P < 0.01). One-third of patients (18 of 59; 31%) with mild/moderate adverse events (which were mainly central nervous system symptoms) continued the regimen; these patients, compared with those discontinuing therapy, showed better perception of therapy (mean score 14.4 versus 12.1, respectively; P = 0.05) and greater satisfaction during therapy (mean score 50.6 versus 44.6, respectively; P = 0.04).
  
  
  CONCLUSIONS
  Patients' beliefs and satisfaction with therapy influence the durability of the first antiretroviral regimen. These patient-related factors modulate the impact of mild adverse events, and could explain differences in the rate of discontinuation.
authors.affiliation: Department of Infectious Diseases, Ramon y Cajal Hospital, Madrid, Spain.
authors.forename: J L
authors.initials: JL
authors.lastname: Casado
authors.affiliation: Department of Infectious Diseases, Ramon y Cajal Hospital, Madrid, Spain.
authors.forename: A
authors.initials: A
authors.lastname: Marín
authors.affiliation: Department of Pharmacy, Ramon y Cajal Hospital, Madrid, Spain.
authors.forename: V
authors.initials: V
authors.lastname: Romero
authors.affiliation: Department of Infectious Diseases, Ramon y Cajal Hospital, Madrid, Spain.
authors.forename: S
authors.initials: S
authors.lastname: Bañón
authors.affiliation: Department of Infectious Diseases, Ramon y Cajal Hospital, Madrid, Spain.
authors.forename: A
authors.initials: A
authors.lastname: Moreno
authors.affiliation: Department of Infectious Diseases, Ramon y Cajal Hospital, Madrid, Spain.
authors.forename: M J
authors.initials: MJ
authors.lastname: Perez-Elías
authors.affiliation: Department of Infectious Diseases, Ramon y Cajal Hospital, Madrid, Spain.
authors.forename: S
authors.initials: S
authors.lastname: Moreno
authors.affiliation: Department of Pharmacy, Ramon y Cajal Hospital, Madrid, Spain.
authors.forename: M A
authors.initials: MA
authors.lastname: Rodriguez-Sagrado
mesh_terms: D000328:Adult; D000480:Alkynes; D019380:Anti-HIV Agents / Q000009:adverse effects* / Q000627:therapeutic use; D023241:Antiretroviral Therapy, Highly Active / Q000009:adverse effects; D048588:Benzoxazines / Q000009:adverse effects* / Q000627:therapeutic use; D015331:Cohort Studies; D003521:Cyclopropanes; D005260:Female; D015658:HIV Infections / Q000188:drug therapy* / Q000523:psychology*; D006801:Humans; D008297:Male; D008875:Middle Aged; D017060:Patient Satisfaction / Q000706:statistics & numerical data; D010549:Personal Satisfaction; D016016:Proportional Hazards Models; D016896:Treatment Outcome
chemical_list: D000480:Alkynes; D019380:Anti-HIV Agents; D048588:Benzoxazines; D003521:Cyclopropanes; C098320:efavirenz
keywords: HIV; antiretroviral durability; patient beliefs; psychosocial; satisfaction