Menstrual cycle phase and single tablet antiretroviral medication adherence in women with HIV.
Suboptimal adherence to antiretroviral (ARV) therapy among HIV-infected individuals is associated with increased risk of progression to AIDS and the development of HIV resistance to ARV medications. To examine whether the luteal phase of the menstrual cycle is independently associated with suboptimal adherence to single tablet regimen (STR) ARV medication, data were analyzed from a multicenter cohort study of HIV-infected women who reported regular menstrual cycles and were taking an STR. In a cross-sectional analysis, suboptimal adherence to an STR among women in their follicular phase was compared with suboptimal adherence among women in their luteal phase. In two-way crossover analyses, whereby the same woman was assessed for STR medication adherence in both her follicular and luteal phases, the estimated exact conditional odds of non-adherence to an STR was measured. In adjusted logistic regression analysis of the cross-sectional data (N=327), women with ≤12 years of education were more than three times more likely to have suboptimal adherence (OR=3.6, p=.04) compared to those with >12 years of education. Additionally, women with Center for Epidemiological Studies Depression Scale (CES-D) scores ≥23 were 2.5-times more likely to have suboptimal adherence (OR=2.6, p=.02) compared to those with CES-D scores <23. In conditional logistic regression analyses of the crossover data (N=184), having childcare responsibilities was associated with greater odds of ≤95% adherence. Menstrual cycle phase was not associated with STR adherence in either the cross-sectional or crossover analyses. The lack of association between phase of the menstrual cycle and adherence to an STR in HIV-infected women means attention can be given to other more important risk factors for suboptimal adherence, such as depression, level of education, and childcare responsibilities.
a Departments of Clinical Pharmacy and of Medicine , University of California , 3333 California Street, Suite 420, San Francisco , CA 94143-0613 , USA.
Nancy A
NA
Hessol
b Department of Medicine, College of Medicine and Department of Community Health Sciences, School of Public Health , State University of New York Downstate Medical Center , 450 Clarkson Avenue, Brooklyn , NY , USA.
Susan
S
Holman
c Department of Obstetrics & Gynecology , Maimonides Medical Center , 967 48th Street, Brooklyn , NY , USA.
Howard
H
Minkoff
d CORE Center , Cook County Health and Hospital System , 2225 W. Harrison Street, Chicago , IL , USA.|e Department of Medicine , Cook County Health and Hospital System and Rush University , 2225 W. Harrison Street, Chicago , IL , USA.
Mardge H
MH
Cohen
f Department of Epidemiology , Bloomberg School of Public Health , Johns Hopkins University, 615 N. Wolfe Street, Baltimore , MD , USA.
Elizabeth T
ET
Golub
g Georgetown University School of Medicine , 2115 Wisconsin Avenue, NW, Washington DC , USA.
Seble
S
Kassaye
h Department of Preventive Medicine , Keck School of Medicine, University of Southern California , 1540 Alcazar, Los Angeles , CA , USA.
Roksana
R
Karim
i Division of Internal Medicine , Montefiore Medical Center , 3311 Bainbridge Avenue, Bronx , NY , USA.
Oluwakemi
O
Sosanya
j Department of Clinical Pharmacy , University of California , 3333 California Street, San Francisco , CA , USA.
Christopher
C
Shaheen
k Department of Obstetrics and Gynecology , New York University School of Medicine , 180 Varick Street, New York , NY , USA.
Zaher
Z
Merhi
D000328:Adult; D044966:Anti-Retroviral Agents / Q000627:therapeutic use*; D018592:Cross-Over Studies; D003430:Cross-Sectional Studies; D005260:Female; D005498:Follicular Phase / Q000502:physiology / Q000523:psychology*; D015658:HIV Infections / Q000188:drug therapy* / Q000523:psychology; D006801:Humans; D008183:Luteal Phase / Q000378:metabolism / Q000502:physiology / Q000523:psychology*; D055118:Medication Adherence; D008875:Middle Aged; D012044:Regression Analysis; D012959:Socioeconomic Factors; D013607:Tablets / Q000627:therapeutic use*; D055815:Young Adult
D044966:Anti-Retroviral Agents; D013607:Tablets
HIV; medication adherence; menstrual phase; women