Trajectories of Antiretroviral Therapy Adherence and Virologic Failure in Women with HIV in the United States

• Authors: Abubaker Ibrahim Elbur, Massachusetts General Hospital; Musie Ghebremichael, Massachusetts Institute of Technology; Deborah Konkle-Parker, University of Mississippi; Deborah L. Jones, University of Miami; Shelby Collins, Emory University; Adaora A. Adimora, University of North Carolina Chapel Hill; Michael F. Schneider, Johns Hopkins University; Mardge H. Cohen, John H. Stroger, Jr. Hospital of Cook County; Bani Tamraz, University of California San Francisco; Michael Plankey, Georgetown University; Tracey Wilson, SUNY Downstate Health Sciences University; Adebola Adedimeji, Albert Einstein College of Medicine of Yeshiva University; Jessica Haberer, Massachusetts General Hospital; Denise L. Jacobson, Center for Biostatistics in AIDS Research
• Journal Title: Journal of Acquired Immune Deficiency Syndromes
• Volume: Volume 93, Number 2
• Publisher: Wolters Kluwer | 2023-06-01, Pages 162-170
• Type of Work: Article | Final Publisher PDF
• Publisher DOI: http://doi.org/10.1097/QAI.0000000000003174
• Subjects: Biology, Virology; Health Sciences, Immunology
• Keywords: Humans; Female; United States; Middle Aged; HIV Infections; Anti-HIV Agents; Antiretroviral Therapy, Highly Active; Anti-Retroviral Agents; Medication Adherence; Viral Load

Abstract

Background:Women with HIV (WHIV) in the United States face many challenges with adherence to antiretroviral therapy (ART), and suboptimal adherence often leads to virologic failure. This study aimed to determine the association between ART adherence trajectories and the risk of virologic failure.Methods:We included WHIV (aged 18 years or older) enrolled in the Women's Interagency HIV Study in the United States from April 2014 to September 2019 who had at least 2 consecutive measurements of HIV RNA and ≥3 measurements of self-reported adherence. Group-based trajectory modeling was used to identify adherence trajectories. Cox proportional hazard ratios were used to measure the association.Main Outcome Measure:Virologic failure was defined as HIV RNA ≥200 copies/mL at 2 consecutive visits.Results:We included 1437 WHIV (median age 49 years). Of all women, 173 (12.0%) experienced virologic failure. Four adherence trajectories were identified, namely "consistently high"(26.3%), "moderate increasing"(9.5%), "moderate decreasing"(30.6%), and "consistently low"(33.5%). Women in the consistently low adherence group consumed alcohol and experienced depression more than other groups. Compared with the "consistently high"trajectory, the risk of virologic failure was higher among women with "consistently low"[adjusted hazard ratio (aHR) 2.8; 95% confidence interval (CI): 1.6 to 4.9; P < 0.001] and "moderate decreasing"adherence trajectories (aHR 1.8; 95% CI: 1.0 to 3.2; P = 0.04), but it was similar to those with "moderate increasing"adherence trajectory (aHR 1.0; 95% CI: 0.4 to 2.5; P = 0.94).Conclusions:Adherence to ART remains a challenge among WHIV. Multilevel behavioral interventions to address poor adherence, alcohol consumption, and depression are needed.