Self-reported non-adherence to antiretroviral therapy repeatedly assessed by two questions predicts treatment failure in virologically suppressed patients

Publication

Self-reported non-adherence to antiretroviral therapy repeatedly assessed by two questions predicts treatment failure in virologically suppressed patients

Journal Paper/Review - Jan 1, 2008

Glass Tracy R, Bucher Heiner C, Weber Rainer, Rickenboch Martin, Bernasconi Enos, Vernazza Pietro, Covassini Matthias, Furrer Hansjakob, Battegay Manuel, Hirschel Bernard, De Geest Sabina, Swiss HIV Cohort Study

Units

Division of Infectious Diseases, Infection Prevention and Travel Medicine

PubMed

18389901

Citation

Glass T, Bucher H, Weber R, Rickenboch M, Bernasconi E, Vernazza P, Covassini M, Furrer H, Battegay M, Hirschel B, De Geest S, Swiss HIV Cohort Study. Self-reported non-adherence to antiretroviral therapy repeatedly assessed by two questions predicts treatment failure in virologically suppressed patients. Antiviral therapy 2008; 13:77-85.

Type

Journal Paper/Review (English)

Journal

Antiviral therapy 2008; 13

Publication Date

Jan 1, 2008

Issn Print

1359-6535

Pages

77-85

Brief description/objective

BACKGROUND: The aim of this study was to explore the predictive value of longitudinal self-reported adherence data on viral rebound. METHODS: Individuals in the Swiss HIV Cohort Study on combined antiretroviral therapy (cART) with RNA <50 copies/ml over the previous 3 months and who were interviewed about adherence at least once prior to 1 March 2007 were eligible. Adherence was defined in terms of missed doses of cART (0, 1, 2 or >2) in the previous 28 days. Viral rebound was defined as RNA >500 copies/ml. Cox regression models with time-independent and -dependent covariates were used to evaluate time to viral rebound. RESULTS: A total of 2,664 individuals and 15,530 visits were included. Across all visits, missing doses were reported as follows: 1 dose 14.7%, 2 doses 5.1%, >2 doses 3.8% taking <95% of doses 4.5% and missing > or =2 consecutive doses 3.2%. In total, 308 (11.6%) patients experienced viral rebound. After controlling for confounding variables, self-reported non-adherence remained significantly associated with the rate of occurrence of viral rebound (compared with zero missed doses: 1 dose, hazard ratio [HR] 1.03, 95% confidence interval [CI] 0.72-1.48; 2 doses, HR 2.17, 95% CI 1.46-3.25; >2 doses, HR 3.66, 95% CI 2.50-5.34). Several variables significantly associated with an increased risk of viral rebound irrespective of adherence were identified: being on a protease inhibitor or triple nucleoside regimen (compared with a non-nucleoside reverse transcriptase inhibitor), >5 previous cART regimens, seeing a less-experienced physician, taking co-medication, and a shorter time virally suppressed. CONCLUSIONS: A simple self-report adherence questionnaire repeatedly administered provides a sensitive measure of non-adherence that predicts viral rebound.