Identifying Risk of Viral Failure in Treated HIV-Infected Patients Using Different Measures of Adherence: The Antiretroviral Therapy Cohort Collaboration

• Type of Material: Article
• Authors: Suzanne M. Ingle, University of Bristol; Heidi M. Crane, University of Washington; Tracy R. Glass, Swiss Tropical and Public Health Institute; Benita Yip, British Columbia Center for Excellence in HIV/AIDS; Viviane D. Lima, British Columbia Center for Excellence in HIV/AIDS; M John Gill, University of Calgary; Nikola Hanhoff, Southern Alberta Clinic; Adriana Ammassari, Istituto Nazionale Malattie Infettive; Michael J. Mugavero, University of Alabama Birmingham; Jan P. Tate, Yale University; Jodie L. Guest, Emory University; Nicholas L. Turner, University of Bristol; Margaret T. May, University of Bristol; Jonathan A. C. Sterne, University of Bristol
• Language: English
• Date: 2018-10-01
• Publisher: MDPI
• Publication Version: Final Published Version
• Copyright Statement: © 2018 by the authors.
• License: Creative Commons Attribution 4.0 International
• Final Published Version (URL): http://dx.doi.org/10.3390/jcm7100328
• Title of Journal or Parent Work: Journal of Clinical Medicine
• ISSN: 2077-0383
• Volume: 7
• Issue: 10
• Grant/Funding Information: European data were supplied by COHERE which is supported by the European Union Seventh Framework Programme (FP7/2007–2013) under EuroCoord grant agreement number 260694.; Jonathan Sterne was supported by NIHR Senior Investigator Award NF-SI-0611-10168.; The COHERE study group has received unrestricted funding from Agence Nationale de Recherches sur le SIDA et les Hépatites Virales, France; HIV Monitoring Foundation, the Netherlands; and the Augustinus Foundation, Denmark.; Also the Michael Smith Foundation for Health Research, the Canadian Institutes of Health Research, the VHA Office of Research and Development and unrestricted grants from Abbott, Gilead, Tibotec-Upjohn, ViiV Healthcare, MSD, GlaxoSmithKline, Pfizer, Bristol Myers Squibb, Roche and Boehringer-Ingelheim.; Dr. Lima is supported by a grant the Canadian Institutes of Health Research (CIHR; MOP-125948), by a Scholar Award from the Michael Institute for Health Research and a New Investigator award from CIHR.; Sources of funding of individual cohorts include, for ICONA the Italian Ministry of Health and unrestricted grants from Abbvie, BMS, Gilead, MSD, Janssen and ViiV Italy; for SHCS the Swiss National Science Foundation (grant 33CS30_134277); for HOMER the Pharmacare program of the British Columbia Ministry of Health; for Alberta the Alberta Government; for UW the National Institutes of Health (NIH) [UW Center for AIDS Research (CFAR) (NIH grant P30 AI027757); for UAB, UAB CFAR (NIH grant P30-AI027767); for VACS the National Institute on Alcohol Abuse and Alcoholism (U10-AA13566, U24-AA020794), for HAVACS, the US Department of Veterans Affairs.; This work was supported by the UK Medical Research Council (MRC) [grant number MR/J002380/1] and the UK Department for International Development (DFID) under the MRC/DFID Concordat agreement and is also part of the EDCTP2 programme supported by the European Union.
• Keywords: REFILL ADHERENCE; General & Internal Medicine; antiretroviral therapy; TREATMENT RESPONSE; ASSOCIATION; SYMPTOMS; HIV; cohort studies; INDIVIDUALS; ORAL HYPOGLYCEMIC AGENTS; SELF-REPORTED ADHERENCE; PHARMACY RECORDS; adherence; MEDICATION ADHERENCE; Medicine, General & Internal; Science & Technology; HAART; viral failure; Life Sciences & Biomedicine
• Research Categories: Health Sciences, Public Health

Abstract

Adherence to antiretroviral therapy (ART) is critical for successful treatment of Human Immunodeficiency Virus (HIV), but comparisons across settings are difficult because adherence is measured in different ways. We examined utility of different adherence measures for identification of patients at risk of viral failure (VF). Eight cohorts in the ART Cohort Collaboration contributed data from pharmacy refills or self-report questionnaires collected between 1996 and 2013 (N = 11689). For pharmacy data (N = 7156), we examined associations of percentage adherence during the 1st year of ART with VF (>500 copies/mL) at 1 year. For self-report data (N = 4533), we examined 28-day adherence with VF based on closest viral load measure within 6 months after questionnaire date. Since adherence differed markedly by measurement type, we defined different cut-off points for pharmacy (lower <45%, medium 45⁻99%, higher 100%) and self-report (lower ≤95%, medium 96⁻99%, higher 100%) data. Adjusted odds ratios (ORs) for VF in lower and medium, compared to higher adherence groups, were 23.04 (95% CI: 18.44⁻28.78) and 3.84 (3.36⁻4.39) for pharmacy data. For self-report data, they were 3.19 (2.31⁻4.40) and 1.08 (0.80⁻1.46). Both types of measure were strongly associated with VF. Although adherence measurements over longer time-frames are preferable for prediction, they are less useful for intervention.