title: Self-reported nonadherence to antiretroviral therapy as a predictor of viral failure and mortality.
abstract: OBJECTIVE
  To determine the effect of nonadherence to antiretroviral therapy (ART) on virologic failure and mortality in naive individuals starting ART.
  
  
  METHODS
  Prospective observational cohort study.
  
  
  METHODS
  Eligible individuals enrolled in the Swiss HIV Cohort Study, started ART between 2003 and 2012, and provided adherence data on at least one biannual clinical visit. Adherence was defined as missed doses (none, one, two, or more than two) and percentage adherence (>95, 90-95, and <90) in the previous 4 weeks. Inverse probability weighting of marginal structural models was used to estimate the effect of nonadherence on viral failure (HIV-1 viral load >500 copies/ml) and mortality.
  
  
  RESULTS
  Of 3150 individuals followed for a median 4.7 years, 480 (15.2%) experienced viral failure and 104 (3.3%) died, 1155 (36.6%) reported missing one dose, 414 (13.1%) two doses and, 333 (10.6%) more than two doses of ART. The risk of viral failure increased with each missed dose (one dose: hazard ratio [HR] 1.15, 95% confidence interval 0.79-1.67; two doses: 2.15, 1.31-3.53; more than two doses: 5.21, 2.96-9.18). The risk of death increased with more than two missed doses (HR 4.87, 2.21-10.73). Missing one to two doses of ART increased the risk of viral failure in those starting once-daily (HR 1.67, 1.11-2.50) compared with those starting twice-daily regimens (HR 0.99, 0.64-1.54, interaction P = 0.09). Consistent results were found for percentage adherence.
  
  
  CONCLUSIONS
  Self-report of two or more missed doses of ART is associated with an increased risk of both viral failure and death. A simple adherence question helps identify patients at risk for negative clinical outcomes and offers opportunities for intervention.
authors.affiliation: aBasel Institute for Clinical Epidemiology and Biostatistics, University Hospital Basel bSwiss Tropical and Public Health Institute cUniversity of Basel, Basel, Switzerland dDepartment of Social Medicine, University of Bristol, Bristol, UK eCommunity pharmacy, Department of Ambulatory Care and Community Medicine, University of Lausanne fCommunity pharmacy, School of Pharmaceutical Sciences, University of Geneva, University of Lausanne, Lausanne gInstitute of Nursing Science, University of Basel, Basel hDivision of Infectious Diseases, Kantonsspital St. Gallen, St. Gallen iDepartment of Infectious Diseases, Bern University Hospital and University of Bern, Bern jDivision of Infectious Diseases and Hospital Epidemiology University Hospital Zurich and University of Zurich, Zurich kDivision of Infectious Diseases, Ospedale Civico Lugano, Lugano lDivision of Infectious Diseases, University Hospital Geneva, Geneva mSwiss HIV Cohort Data Center, University Institute of Social and Preventive Medicine Lausanne, Lausanne nDivision of Infectious Diseases and Hospital Epidemiology, University Hospital Basel, Basel, Switzerland.
authors.forename: Tracy R
authors.initials: TR
authors.lastname: Glass
authors.forename: Jonathan A C
authors.initials: JA
authors.lastname: Sterne
authors.forename: Marie-Paule
authors.initials: MP
authors.lastname: Schneider
authors.forename: Sabina
authors.initials: S
authors.lastname: De Geest
authors.forename: Dunja
authors.initials: D
authors.lastname: Nicca
authors.forename: Hansjakob
authors.initials: H
authors.lastname: Furrer
authors.forename: Huldrych F
authors.initials: HF
authors.lastname: Günthard
authors.forename: Enos
authors.initials: E
authors.lastname: Bernasconi
authors.forename: Alexandra
authors.initials: A
authors.lastname: Calmy
authors.forename: Martin
authors.initials: M
authors.lastname: Rickenbach
authors.forename: Manuel
authors.initials: M
authors.lastname: Battegay
authors.forename: Heiner C
authors.initials: HC
authors.lastname: Bucher
mesh_terms: D000328:Adult; D044966:Anti-Retroviral Agents / Q000008:administration & dosage*; D005260:Female; D015658:HIV Infections / Q000188:drug therapy* / Q000401:mortality*; D006801:Humans; D008297:Male; D055118:Medication Adherence; D008875:Middle Aged; D011446:Prospective Studies; D016019:Survival Analysis; D013557:Switzerland / Q000453:epidemiology; D017211:Treatment Failure; D019562:Viral Load
chemical_list: D044966:Anti-Retroviral Agents