HIV antiviral drug resistance: patient comprehension

Abstract

A patient's understanding and use of healthcare information can affect their decisions regarding treatment. Better patient understanding about HIV resistance may improve adherence to therapy, decrease population viral load and extend the use of first-line HIV therapies. We examined knowledge of developing HIV resistance and explored treatment outcomes in a cohort of HIV+ persons on highly active antiretroviral therapy (HAART). The longitudinal investigations into supportive and ancillary health services (LISA) cohort is a prospective study of HIV+ persons on HAART. A comprehensive interviewer-administrated survey collected socio-demographic variables. Drug resistance knowledge was determined using a three-part definition. Clinical markers were collected through linkage with the Drug Treatment Program (DTP) at the British Columbia Centre for Excellence in HIV/AIDS. Categorical variables were compared using Fisher's Exact Test and continuous variables using the Wilcoxon rank-sum test. Proportional odds logistic regression was performed for the adjusted multivariable analysis. Of 457 LISA participants, less than 4% completely defined HIV resistance and 20% reported that they had not discussed resistance with their physician. Overall, 61% of the cohort is ≥95% adherent based on prescription refills. Owing to small numbers pooling was preformed for analyses. The model showed that being younger (OR=0.97, 95% CI: 0.95–0.99), having greater than high school education (OR=1.64, 95% CI: 1.07–2.51), discussing medication with physicians (OR=3.67, 95% CI: 1.76–7.64), having high provider trust (OR=1.02, 95% CI: 1.01–1.03), and receiving one-to-one counseling by a pharmacist (OR=2.14, 95% CI: 1.41–3.24) are predictive of a complete or partial definition of HIV resistance. The probability of completely defining HIV resistance increased from 15.8 to 63.9% if respondents had discussed HIV medication with both a physician and a pharmacist. Although the understanding of HIV resistance showed no differences in treatment outcomes in this cohort, overall adherence and complete understanding of HIV resistance were low. If patient understanding could be improved through discussions with physicians and pharmacists, potential exists to enhance overall adherence and treatment outcomes.

Keywords:

• patient comprehension
• HIV/AIDS
• antiretroviral drug resistance
• health literacy

Acknowledgements

Many thanks to all LISA participants, Mark Phillips, Elizabeth Pipes, Katrina Duncan, Alexis Palmer, Andy Mtambo, Oghenowede Eyawo, and Alexandra Borwein for their assistance and guidance. The Longitudinal Investigation into Ancillary Services is supported by the Canadian Institute for Health Research (CIHR). Robert S. Hogg has held grant funding from the National Institutes of Health, Canadian Institutes of Health Research National Health Research Development Program, and Health Canada. He has also received funding from Agouron Pharmaceuticals Inc., Boehringer Ingelheim Pharmaceuticals Inc., Bristol-Myers Squibb, GlaxoSmithKline, and Merck Frosst Laboratories for participating in continued medical education programs. Julio S.G. Montaner has received grants from, served as an ad hoc advisor to, or spoken at various events sponsored by Abbott, Argos Therapeutics, Bioject Inc., Boehringer Ingelheim, BMS, Gilead Sciences, GlaxoSmithKline, Hoffmann-La Roche, Janssen-Ortho, Merck Frosst, Pfizer, Schering, Serono Inc., TheraTechnologies, Tibotec, and Trimeris. He has also held grant funding from the Canadian Institutes of Health Research and National Institutes of Health. He has also received funding for research and continuing medical education programs from a number of pharmaceutical companies including Abbott, Boehringer Ingelheim, and GlaxoSmithKline.