While Adherence to ART Regimens Has Improved Among People With HIV, Rates Remain Suboptimal

For people living with HIV, adherence to antiretroviral therapy (ART) is essential for achieving viral suppression and removing the risk of HIV transmission, and a new study is offering positive findings that adherence has improved over time.

Accounting for newer ART regimens, wider use of ART, and more emphasis being placed on adherence, the researchers looked at adherence rates between 2001 and 2012 and found that the proportion of people living with HIV with more than 90% adherence to ART increased from 33.5% in 2001 to 52.4% in 2010.

The improvement, according to the authors, could in part be attributed to changes in ART initiation guidelines. In 2001, HHS guidelines recommended initiating ART for those with CD4 counts of less than 200 cells/mm³, which increased to less than 350 cells/mm³ in 2007 and less than 500 cells/mm³ in 2009. In March 2012, the guidelines changed to recommend that all people with HIV, regardless of their CD4 count, initiate ART. This was consistent with the International Antiviral Society-USA’s guideline change in 2012, in which they also recommended that all people with HIV initiate ART, regardless of CDT count.

“Although HIV+ persons in recent periods have likely initiated ART at a higher CD4 count on average than those in earlier periods, a recent systematic review found no consistent association between baseline CD4 count and ART adherence in routine clinical settings,” wrote the researchers.

However, despite the improvement, adherence rates remain low, never exceeding 60% for any medication examined, they noted.

Throughout the study period, researchers captured data on 23,343 people with HIV who initiated ART between 2001 and 2010. The data came from Medicaid Analytic eXtract files from 14 states accounting for 75% of the HIV prevalence in the country: New York, California, Florida, Texas, Maryland, New Jersey, Pennsylvania, Illinois, Georgia, North Carolina, Virginia, Louisiana, Ohio, and Massachusetts.

Compared with those initiating ART in 2001 to 2003, those initiating treatment between 2007 and 2010 had a 53% increased odds of 90% adherence. Certain patient characteristics also played a role in the likelihood of adhering to their ART regimen. For example, those who were older, male, on new ART regimens, or had no history of substance use were more likely to adhere to their regimen. Those who lived in New York or California were also more likely to adhere to their regimen.

In order to better understand trends in medication adherence, the researchers compared ART adherence with adherence to medications for other common chronic conditions, including statins, angiotensin-converting enzyme inhibitors, or angiotensin receptor blockers.

Throughout the study period, there were no or minimal improvements in adherence to these medications, “providing strong evidence that the changes in ART cannot be solely explained by general secular trends,” explained the researchers.

Reference

Youn B, Shireman T, Lee Y, Galárraga O, Wilson I. Trends in medication adherence in HIV patients in the US, 2001 to 2012: an observational cohort study [published online August 23, 2019]. J Int AIDS Soc. doi: 10.1002/jia2.25382.