The value of patient-reported adherence to antiretroviral therapy in predicting virologic and immunologic response. California Collaborative Treatment Group.

Authors

Haubrich RH, Little SJ, Currier JS, et al. 

Institution

University of California and the UCSD Treatment Center Data and Biostatistical Unit, San Diego, USA.

Source

AIDS 1999 Jun 18; 13(9) :1099-107.

Abstract

OBJECTIVE
To correlate self-reported antiretroviral adherence with virologic suppression.
DESIGN
Prospective observational study of adherence to therapy nested in a randomized comparative trial of frequent versus infrequent monitoring of plasma HIV RNA.
SETTING
Five university-affiliated HIV clinics.
PATIENTS
A group of 173 HIV-infected patients with a mean baseline CD4 count of 142 x 10(6) cells/l (range 3-515) of whom 164 and 119 completed adherence questionnaires at 2 and 6 months, respectively.
INTERVENTION
Individualized, unrestricted antiretroviral therapy.
MEASUREMENTS
Patients were classified into four groups by adherence to therapy in the previous 4 weeks (< 80%, 80-95%, 95-99%, 100%). Plasma HIV RNA levels and CD4 lymphocyte counts were measured bimonthly.
RESULTS
Recreational drug or alcohol use was associated with decreased adherence, whereas frequency of HIV RNA monitoring, demographic variables, (age, gender, education, and risk group) and stage of disease had no effect. Greater HIV suppression at 6 months was seen across four categories of increasing adherence (P = 0.009 for linear trend). Patients reporting < 80% adherence at 6 months had a 0.2 log10 copies/ml increase in HIV RNA and a loss of 19 x 10(6) CD4 cells/l compared with a 1.1 log10 copies/ml decrease in HIV RNA and an increase of 72 x 10(6) CD4 cells/l in those reporting 100% adherence (P = 0.02).
CONCLUSION
Self-reported poor adherence (< 80%) and drug or alcohol use predicted non-response of HIV RNA at 6 months of antiretroviral therapy.

Mesh

Adult
Anti-HIV Agents
CD4 Lymphocyte Count
Female
Forecasting
HIV Infections
HIV-1
Humans
Male
Middle Aged
Patient Compliance
Prospective Studies
RNA, Viral
Treatment Outcome
Viral Load

Language

eng

Pub Type(s)

Clinical Trial Journal Article Randomized Controlled Trial Research Support, Non-U.S. Gov't

PubMed ID

10397541