Adherence to protease inhibitor therapy and outcomes in patients with HIV infection

Paterson, David L., Swindells, Susan, Mohr, Jeffrey, Brester, Michelle, Vergis, Emanuel N., Squier, Cheryl, Wagener, Marilyn M. and Singh, Nina (2000) Adherence to protease inhibitor therapy and outcomes in patients with HIV infection. Annals of Internal Medicine, 133 1: 21-30.

Author Paterson, David L.
Swindells, Susan
Mohr, Jeffrey
Brester, Michelle
Vergis, Emanuel N.
Squier, Cheryl
Wagener, Marilyn M.
Singh, Nina
Title Adherence to protease inhibitor therapy and outcomes in patients with HIV infection
Journal name Annals of Internal Medicine   Check publisher's open access policy
ISSN 0003-4819
Publication date 2000-07
Sub-type Article (original research)
Volume 133
Issue 1
Start page 21
End page 30
Total pages 10
Place of publication Philadelphia, PA, U.S.A.
Publisher American College of Physicians
Language eng
Subject C1
1103 Clinical Sciences
Formatted abstract
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.

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.

Prospective, observational study.

HIV clinics in a Veterans Affairs medical center and a university medical center.

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).

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).

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.

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.

© the American College of Physicians 2000
Keyword Patient compliance
HIV positive persons
Protease inhibitors
Outcome assessment
Q-Index Code C1
Additional Notes Erratum: Annals of Internal Medicine, July 2002, Vol.136/3, pages 21-30

Document type: Journal Article
Sub-type: Article (original research)
Collection: UQ Centre for Clinical Research Publications
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Created: Tue, 07 Sep 2010, 17:09:32 EST