Similar Adherence Rates Favor Different Virologic Outcomes for Patients Treated with Nonnucleoside Analogues or Protease Inhibitors
Open Access
- 1 January 2005
- journal article
- Published by Oxford University Press (OUP) in Clinical Infectious Diseases
- Vol. 40 (1), 158-163
- https://doi.org/10.1086/426595
Abstract
Background. This prospective study verified the effect of adherence on the risk of virologic failure. Methods. At enrollment in the study, a total of 543 patients who were following a steady (duration, ⩾6 months) and effective (viral load, 500 HIV RNA copies/mL. Results. Only the type of treatment and the adherence rate at baseline were significantly associated with the virologic end point. Among patients who reported an adherence rate of ⩽75%, the rate of virologic failure was 17.4%; this rate decreased to 12.2% for patients whose adherence rate was 76%–85%, to 4.3% for patients whose adherence rate was 86%–95%, and to 2.4% for patients whose adherence rate was >95%. When analysis was adjusted according to the type of regimen received, patients who were receiving protease inhibitor (PI)—based HAART and who had an adherence rate of up to 85% had a virologic failure rate of >20%, whereas, only for patients who were receiving nonnucleoside reverse-transcriptase inhibitor (NNRTI)—based HAART and who had an adherence rate of ⩽75%, the virologic failure rate was >10%. For the comparison of NNRTI-treated patients and PI-treated patients with an adherence rate of 75%–95%, the odds ratio was 0.157 (95% confidence interval, 0.029–0.852). The number of pills and daily doses received correlated with the reported adherence rate. Conclusions. Patients receiving NNRTIs report a higher rate of adherence than do patients receiving PIs. Adherence is significantly influenced by the number of pills and daily doses received. Low adherence is a major determinant of virologic failure; however, different therapies have different cutoff values for adherence that determine a significant increment of risk.Keywords
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