New Publications in HIV : Archive

23 April 2009

The combined effect of modern highly active antiretroviral therapy regimens and adherence on mortality over time.

Lima VD et al. J Acquir Immune Defic Syndr 2009 Feb 13. [Epub ahead of print] • This study investigated the impact of longitudinal adherence on survival in drug-naïve individuals starting HAART.
• Non-adherence over time (<95%) was strongly associated with a higher risk of mortality (HR: 3.13; 95% CI: 1.95–5.05).
• Conclusions: Incomplete adherence to HAART over time was strongly associated with increased mortality. Non-adherent patients on EFV-based NNRTI therapies had a higher risk.
Link 23 April 2009

Adherence to first-line antiretroviral therapy affects non-virologic outcomes among patients on treatment for more than 12 months in Lusaka, Zambia.

Chi BH et al. Int J Epidemiol 2009 Feb 17. [Epub ahead of print] • This study investigated the correlation between clinical outcomes and the medication possession ratio (MPR), a pharmacy-based measure of adherence.
• MPR was predictive of clinical outcomes and immunologic response.
• Conclusion: MPR may have a role in guiding monitoring and clinical care in resource-constrained settings.
Link 29 April 2009

Do benefits of earlier antiretroviral treatment initiation outweigh harms for individuals at risk for poor adherence?

Braithwaite RS et al. Clin Infect Dis 2009;48:822–6. • This study used a validated computer simulation of HIV disease progression to compare alternative treatment thresholds for patients with suboptimal adherence.
• Earlier treatment increased life expectancy across a wide range of adherence (50–100%).
• Conclude: Delaying treatment for patients with suboptimal adherence may not always be appropriate.
Link 29 April 2009

Editorial Balancing adherence concerns with the risks of HIV disease progression.

Johnson SC. Clin Infect Dis 2009;48:827–8. • This study used a validated computer simulation of HIV disease progression to compare alternative treatment thresholds for patients with suboptimal adherence.
• Earlier treatment increased life expectancy across a wide range of adherence (50–100%).
• Conclude: Delaying treatment for patients with suboptimal adherence may not always be appropriate.
Link 06 May 2009

Challenges for Scaling up ART in a Resource-Limited Setting: A Retrospective Study in Kibera, Kenya.

Unge C et al. J Acquir Immune Defic Syndr 2009 Feb 12. [Epub ahead of print] • This retrospective cohort study investigated levels of dropout and adherence in an ART programme in Kibera, Kenya.
• The dropout rate was 23 per 100 person-years and the probability of retention in the program at 6, 12 and 24 months was 0.83, 0.74 and 0.65, respectively.
• Conclusion: Despite free drugs and low associated costs, dropout probabilities were higher and adherence lower versus other sub-Saharan Africa studies. The results show that ART programs in resource-limited settings risk low adherence and retention rates when expanding services.
Link 07 May 2009

The combined effect of modern highly active antiretroviral therapy regimens and adherence on mortality over time.

Lima VD et al. J Acquir Immune Defic Syndr 2009;50:529–36. • This study investigated the impact of longitudinal adherence on survival in drug-naïve individuals starting HAART containing EFV, NVP, or RTV-boosted ATV or LPV.
• Individual adherence decreased significantly over time and non-adherence over time (<95%) was strongly associated with a higher risk of mortality (HR: 3.13; 95% C): 1.95–5.05). Non-adherent (<95%) patients on NNRTI-based and boosted PI-based regimens were 3.61 (95% CI: 2.15–6.06) and 3.25 times (95% CI: 1.63–6.49), respectively, more likely to die than adherent patients.
• Conclusions: Incomplete adherence to HAART over time was strongly associated with increased mortality. Non-adherent patients on EFV-based HAART were at particularly high risk.
Link 16 September 2009

HIV patients with psychiatric disorders are less likely to discontinue HAART.

Himelhoch S, Brown CH, Walkup J et al. AIDS 2009;23:1735–42 • This longitudinal study (2000–2005) in the US investigated whether the presence of a psychiatric disorder among HIV patients is associated with differential rates of discontinuation of HAART and whether the number of mental health visits affected these rates.
• Of 4989 HIV outpatients, 24.8% were diagnosed with a depressive disorder and 9% were diagnosed with serious mental illness.
• Compared with patients with no psychiatric disorders, the hazard probability for discontinuation of HAART was significantly lower in the first and second years among those with serious mental illness (adjusted OR: first year, 0.57 [0.47–0.69]; second year, 0.68 [0.52–0.89]) and in the first year among those with depressive disorders (adjusted OR: first year, 0.61 [0.54–0.69]).
• Conclusions: Patients with psychiatric disorders were significantly less likely to discontinue HAART in the first and second years of treatment. Mental health visits were associated with a decreased risk of discontinuing HAART.
Link 22 October 2009

Alcohol use and antiretroviral adherence: review and meta-analysis.

Hendershot CS, Stoner SA, Pantalone DW et al J Acquir Immune Defic Syndr 2009;52:180–202. • This meta-analysis evaluated the association between alcohol use and ARV adherence.
• Forty studies including >25,000 participants were identified from literature searches.
• Alcohol users were approximately 50–60% as likely to be adherent [OR: 0.548; 95% CI: 0.490–0.612] as non-drinkers or those who drank less.
• Effect sizes for problem drinking were greater (OR: 0.474; 95% CI: 0.408–0.550) than those for any or global drinking (OR: 0.604; 95% CI: 0.531–0.687).
• Conclusions: The results support a significant and reliable association between alcohol use and medication non-adherence.
Link 16 November 2009

The risk of virologic failure decreases with duration of HIV suppression, at greater than 50% adherence to antiretroviral therapy

Rosenblum M, Deeks SG, van der Laan M et al. PLoS One 2009;4:e7196. • This study investigated the hypothesis that the percentage adherence to ART necessary to maintain HIV suppression would decrease the longer the duration of viral suppression.
• Adherence to ART was measured through pill counts. The effect of adherence to ART on the probability of VF during early and late viral suppression was determined.
• Comparing the probability of VF just after achieving viral suppression vs after 12 consecutive months of suppression, there was a statistically significant decrease in the probability of VF for each range of adherence proportions considered, as long as adherence was >50%.
• The estimated risk difference, comparing the probability of VF after 1 month vs after 12 months of continuous viral suppression was 0.47 (95% CI: 0.23–0.63) at 50–74% adherence, 0.29 (95% CI: 0.03–0.50) at 75–89% adherence and 0.36 (95% CI: 0.23–0.48) at 90–100% adherence.
• Conclusions: The risk of VF for adherence >50% declined with a longer duration of continuous viral suppression.
Link