It is well established that excellent adherence to antiretroviral therapy is necessary to achieve optimal response, but the various factors that promote or hinder good adherence are not fully understood.

As reported in the November 15, 2007 issue of Clinical Infectious Diseases, researchers assessed data from 640 HIV positive men and 1304 HIV positive women in 2 prospective cohort studies from 1999 through 2004.

Self-reported adherence to HAART was recorded twice annually. At each study visit, participants were categorized as being 100% adherent if they reported full adherence to their HAART regimen over the past 4 days (for men) or 3 days (for women). Repeated-measures logistic regression models were used to identify predictors for changes in adherence between consecutive visits.

Results

·         Among white men, the prevalence of 100% adherence decreased from 91% in 1998 to 80% in 2003.

·         Among women and African American men, the prevalence of complete adherence was lower (75% and 77% on average, respectively), but stable over time.

·         In both cohorts, the presence of clinical symptoms was independently associated with decreased adherence (odds ratio [OR] 1.38 in men and 1.48 in women).

·         Other factors that predicted decreased adherence were:

o        Depression in men (OR 1.44);

o        Use of alcohol in women (OR 1.81 for binge drinking, 1.52 for moderate-to-heavy drinking, 1.29 for light drinking).

·         The use of illegal/street drugs by men and women (OR 0.61 and 0.58, respectively) and binge drinking by women (OR 0.41) were negatively associated with improving adherence.

·         In both men and women, use of protease inhibitors was associated with decreased adherence compared with non-nucleoside reverse transcriptase inhibitors.

Conclusion

“Adherence to antiretroviral treatment is a dynamic process; modifiable risk factors are associated with increasing and decreasing adherence, suggesting specific interventions,” the authors concluded. “Moreover, the association of these risk factors with changes in adherence may differ by sex.”

Reference  

M Lazo, SJ Gange, TE Wilson, and others. Patterns and Predictors of Changes in Adherence to Highly Active Antiretroviral Therapy: Longitudinal Study of Men and Women. Clinical Infectious Diseases 45(10): 1377-1385. November 15, 2007.