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Limited Patient Adherence to Highly Active Antiretroviral Therapy for HIV-1 Infection in an Observational Cohort Study
Pythia T. Nieuwkerk, MA;
Mirjam A. G. Sprangers, PhD;
David M. Burger, PharmD, PhD;
Richard M. W. Hoetelmans, PharmD, PhD;
Patricia W. H. Hugen, PharmD, PhD;
Sven A. Danner, MD, PhD;
Marchina E. van der Ende, MD, PhD;
Margriet M. E. Schneider, MD, PhD;
Gerrit Schrey, MD, PhD;
Pieter L. Meenhorst, MD, PhD;
Herman G. Sprenger, MD, PhD;
Robert H. Kauffmann, MD, PhD;
Marielle Jambroes, MD;
Margaret A. Chesney, PhD;
Frank de Wolf, MD, PhD;
Joep M. A. Lange, MD, PhD;
for the ATHENA Project
Arch Intern Med. 2001;161:1962-1968.
Background Adherence to highly active antiretroviral therapy (HAART) for human
immunodeficiency syndrome type 1 (HIV-1) infection is essential to sustain
viral suppression and prevent drug resistance. We investigated adherence to
HAART among patients in a clinical cohort study.
Methods Patients receiving HAART had their plasma concentrations of protease
inhibitors or nevirapine measured and completed a questionnaire on adherence.
We determined the percentage of patients who reported taking all antiretroviral
medication on time and according to dietary instructions in the past week.
Drug exposure was compared between patients reporting deviation from their
regimen and fully adherent patients. Among patients who received HAART for
at least 24 weeks, we assessed the association between adherence and virologic
outcome.
Results A total of 224 of 261 eligible patients completed a questionnaire. Forty-seven
percent reported taking all antiretroviral medication on time and according
to dietary instructions. Patients who reported deviation from their regimen
showed lower drug exposure compared with fully adherent patients (median concentration
ratio, 0.81 vs 1.07; P = .001). Among those receiving
HAART for at least 24 weeks, patients reporting deviation from their regimen
were less likely to have plasma HIV-1 RNA levels below 500 copies/mL (adjusted
odds ratio, 4.0; 95% confidence interval, 1.4-11.6) compared with fully adherent
patients.
Conclusions Only half of the patients took all antiretroviral medication in accordance
with time and dietary instructions in the preceding week. Deviation from the
antiretroviral regimen was associated with decreased drug exposure and a decreased
likelihood of having suppressed plasma HIV-1 RNA loads. Patient adherence
should remain a prime concern in the management of HIV-1 infection.
From the Department of Medical Psychology (Ms Nieuwkerk and Dr Sprangers),
Division of Infectious Diseases, Tropical Medicine, and AIDS (Dr Danner),
Department of Human Retrovirology (Dr de Wolf), and the National AIDS Therapy
Evaluation Center (Drs Jambroes and Lange), Academic Medical Center, Amsterdam,
the Netherlands; Department of Clinical Pharmacy, University Medical Center
St Radboud, Nijmegen, the Netherlands (Drs Burger and Hugen); Departments
of Pharmacy and Pharmacology (Dr Hoetelmans) and Internal Medicine (Dr Meenhorst),
Slotervaart Hospital, Amsterdam, the Netherlands; Department of Internal Medicine,
Erasmus University Medical Center, Rotterdam, the Netherlands (Dr van der
Ende); Department of Internal Medicine, Utrecht Medical Center, Utrecht, the
Netherlands (Dr Schneider); Department of Internal Medicine, University Hospital
Maastricht, Maastricht, the Netherlands (Dr Schrey); Department of Internal
Medicine, University Hospital Groningen, Groningen, the Netherlands (Dr Sprenger);
Department of Internal Medicine, Hospital Leyenburg, the Hague, the Netherlands
(Dr Kauffmann); and Center for AIDS Prevention Studies, University of California,
San Francisco (Dr Chesney). Dr Lange has received consulting fees from Abbott
Laboratories, Boehringer Ingelheim, Bristol-Myers Squibb, Chiron Corporation,
Gilead Sciences, GlaxoSmithKline, Roche, and Virco.
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Adherence to HAART: Why Is It So Difficult?
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Arch Intern Med. 2002;162(10):1197-1198.
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