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Adherence and HIV RNA Suppression in the Current Era of Highly Active Antiretroviral Therapy.

ABSTRACT: BACKGROUND:We examined trends in adherence to highly active antiretroviral therapy (HAART) and HIV RNA suppression and estimated the minimum cutoff of adherence to newer HAART formulations needed for HIV RNA suppression by regimen type. METHODS:We used Veterans Affairs pharmacy dispensing data from the Veterans Aging Cohort Study Virtual Cohort between October 2000 and September 2010 and defined adherence as the duration of time the patient had the medications available, relative to the total number of days between refills for all antiretrovirals in a year. Temporal trends in adherence and viral load suppression were examined by the patient's most frequently used HAART regimen in the year. The minimum needed adherence was defined as the level at which the odds of suppression was not significantly different than that observed with ? 95% adherence using repeated-measures logistic regression. RESULTS:A total of 21,865 HAART users contributed 82,217 person-years of follow-up. There was a significant increase (P(trend) < 0.001) in the proportion virally suppressed even among those with <95% adherence (2001: 38% to 2010: 84%), and the trend was similar when restricting to their first HAART regimen. For nonnucleoside reverse transcriptase inhibitor multi-pill users, the odds of suppression did not differ for 85%-89% adherence compared to those with ? 95% adherence [odds ratios: 0.82 (0.64-1.04)], but for protease inhibitor users, the odds of suppression significantly differed if adherence levels were <95% compared to ? 95% adherence. CONCLUSIONS:Although all HIV-infected persons should be instructed to achieve perfect adherence, concerns of slightly lower adherence should not hinder prescribing new HAART regimens early in HIV infection.

SUBMITTER: Viswanathan S

PROVIDER: S-EPMC4482798 | biostudies-literature | 2015 Aug

REPOSITORIES: biostudies-literature

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Adherence and HIV RNA Suppression in the Current Era of Highly Active Antiretroviral Therapy.

Viswanathan Shilpa S Justice Amy C AC Alexander G Caleb GC Brown Todd T TT Gandhi Neel R NR McNicholl Ian R IR Rimland David D Rodriguez-Barradas Maria C MC Jacobson Lisa P LP

Journal of acquired immune deficiency syndromes (1999) 20150801 4

<h4>Background</h4>We examined trends in adherence to highly active antiretroviral therapy (HAART) and HIV RNA suppression and estimated the minimum cutoff of adherence to newer HAART formulations needed for HIV RNA suppression by regimen type.<h4>Methods</h4>We used Veterans Affairs pharmacy dispensing data from the Veterans Aging Cohort Study Virtual Cohort between October 2000 and September 2010 and defined adherence as the duration of time the patient had the medications available, relative ...[more]

PMID: 25886923

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Project description:BackgroundCandidiasis is the most common opportunistic infection seen in human immunodeficiency virus (HIV)-infected individuals. The aim of our study was to estimate the candidiasis rate and evaluate its trend in HIV-infected children in Spain during the era of highly active antiretroviral therapy (HAART) compared to HIV-uninfected children.MethodsWe carried out a retrospective study. Data were obtained from the records of the Minimum Basic Data Set from hospitals in Spain. All HIV-infected children were under 17 years of age, and a group of HIV-uninfected children with hospital admissions matching the study group by gender and age were randomly selected. The follow-up period (1997-2008) was divided into three calendar periods: a) From 1997 to 1999 for early-period HAART; b) from 2000 to 2002 for mid-period HAART; and c) from 2003 to 2008 for late-period HAART.ResultsAmong children with hospital admissions, HIV-infected children had much higher values than HIV-uninfected children during each of the three calendar periods for overall candidiasis rates (150.0 versus 6.1 events per 1,000 child hospital admissions/year (p?<?0.001), 90.3 versus 3.1 (p?<?0.001), and 79.3 versus 10.7 (p?<?0.001), respectively) and for non-invasive Candida mycosis (ICM) rates (118.5 versus 3.8 (p?<?0.001), 85.3 versus 2.3 (p?<?0.001), and 80.6 versus 6.0 (p?<?0.001), respectively). In addition, HIV-infected children also had higher values of ICM rates than HIV-uninfected children, except during the last calendar period when no significant difference was found (32.4 versus 1.2 (p?<?0.001), 11.6 versus 0.4 (p?<?0.001), and 4.6 versus 2.3 (p?=?0.387), respectively). For all children living with HIV/AIDS, the overall candidiasis rate (events per 1,000 HIV-infected children/year) decreased from 1997-1999 to 2000-2002 (18.8 to 10.6; p?<?0.001) and from 2000-2002 to 2003-2008 (10.6 to 5.7; p?=?0.060). Within each category of candidiasis, both non-ICM and ICM rates experienced significant decreases from 1997-1999 to 2003-2008 (15.9 to 5.7 (p?<?0.001) and 4.1 to 0.3 (p?<?0.001), respectively).ConclusionsAlthough the candidiasis rate still remains higher than in the general population (from 1997 to 2008), candidiasis diagnoses have decreased among HIV-infected children throughout the HAART era, and it has ceased to be a major health problem among children with HIV infection.

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Adherence and HIV RNA Suppression in the Current Era of Highly Active Antiretroviral Therapy.

Publications

Adherence and HIV RNA Suppression in the Current Era of Highly Active Antiretroviral Therapy.

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