Adherence to Protease Inhibitor Therapy and Outcomes in Patients with HIV Infection

Bibliographic Data

ID23317651
AuthorsDavid L Paterson (0000-0003-2079-4437, From Veterans Affairs Medical Center and University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania; and University of Nebraska Medical Center, Omaha, Nebraska.), Susan Swindells (0000-0001-5826-6037, From Veterans Affairs Medical Center and University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania; and University of Nebraska Medical Center, Omaha, Nebraska.), Jeffrey Mohr (From Veterans Affairs Medical Center and University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania; and University of Nebraska Medical Center, Omaha, Nebraska.), Michelle Brester (From Veterans Affairs Medical Center and University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania; and University of Nebraska Medical Center, Omaha, Nebraska.), Emanuel N Vergis (0009-0001-6029-1925, From Veterans Affairs Medical Center and University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania; and University of Nebraska Medical Center, Omaha, Nebraska.), Cheryl Squier (From Veterans Affairs Medical Center and University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania; and University of Nebraska Medical Center, Omaha, Nebraska.), Marilyn M Wagener (From Veterans Affairs Medical Center and University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania; and University of Nebraska Medical Center, Omaha, Nebraska.), Nina Singh (0000-0003-2890-1049, From Veterans Affairs Medical Center and University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania; and University of Nebraska Medical Center, Omaha, Nebraska.)
Year2000
Volume133
Issue1
Pages21-30
Publication date2000-07-04
Peer ReviewedYes
Open AccessYes
TypeARTICLE
VenueAnnals of Internal Medicine (JOURNAL)
Journal identifiersISSN: 0003-4819 • E-ISSN: 1539-3704
PublisherAmerican College of Physicians (PUBLISHER • US)
DOI10.7326/0003-4819-133-1-200007040-00004
PMID10877736
OpenAlexW2164099498
LanguageEN
Citations received492
References cited22

BACKGROUND: Combination antiretroviral therapy with protease inhibitors has transformed HIV infection from a terminal condition into one that is manageable. However, the complexity of regimens makes adherence to therapy difficult. OBJECTIVE: To assess the effects of different levels of adherence to therapy on virologic, immunologic, and clinical outcome; to determine modifiable conditions associated with suboptimal adherence; and to determine how well clinicians predict patient adherence. DESIGN: Prospective, observational study. SETTING: HIV clinics in a Veterans Affairs medical center and a university medical center. PATIENTS: 99 HIV-infected patients who were prescribed a protease inhibitor and who neither used a medication organizer nor received their medications in an observed setting (such as a jail or nursing home). MEASUREMENTS: Adherence was measured by using a microelectronic monitoring system. The adherence rate was calculated as the number of doses taken divided by the number prescribed. Patients were followed for a median of 6 months (range, 3 to 15 months). RESULTS: During the study period, 45,397 doses of protease inhibitor were monitored in 81 evaluable patients. Adherence was significantly associated with successful virologic outcome (P < 0.001) and increase in CD4 lymphocyte count (P = 0.006). Virologic failure was documented in 22% of patients with adherence of 95% or greater, 61% of those with 80% to 94.9% adherence, and 80% of those with less than 80% adherence. Patients with adherence of 95% or greater had fewer days in the hospital (2.6 days per 1000 days of follow-up) than those with less than 95% adherence (12.9 days per 1000 days of follow-up; P = 0.001). No opportunistic infections or deaths occurred in patients with 95% or greater adherence. Active psychiatric illness was an independent risk factor for adherence less than 95% (P = 0.04). Physicians predicted adherence incorrectly for 41% of patients, and clinic nurses predicted it incorrectly for 30% of patients. CONCLUSIONS: Adherence to protease inhibitor therapy of 95% or greater optimized virologic outcome for patients with HIV infection. Diagnosis and treatment of psychiatric illness should be further investigated as a means to improve adherence to therapy.

Antiretroviral therapy · Human immunodeficiency virus (HIV) · Observational study · Prospective cohort study · Protease inhibitor (pharmacology) · Veterans Affairs · Viral load · HIV-related health complications and treatments · HIV/AIDS Research and Interventions · Immunology · Internal Medicine · Medication Adherence and Compliance · Medicine