Non-persistence to antiretroviral therapy among adults receiving HIV medical care in the United States

ABSTRACT

Not taking medicine over a specific period of time—non-persistence to antiretroviral therapy (ART)—may be associated with higher HIV-viral load. However, national estimates of non-persistence among U.S. HIV patients are lacking. We examined the association between non-persistence and various factors, including sustained HIV-viral suppression (VS) stratified by adherence, and assessed reasons for non-persistence using Medical Monitoring Project (MMP) data. MMP conducts clinical and behavioral surveillance among cross-sectional representative samples of adults receiving HIV care in the U.S. We analyzed weighted MMP interview and medical record abstraction data collected between 6/2011–5/2015 from 18,423 patients self-reporting ART use. We defined non-persistence as a self-initiated decision to not take ART for ≥2 consecutive days in the past 12-months, non-adherence as missing ≥1 ART dose during the past 3-days and sustained VS as all HIV-viral loads documented in medical record during the past 12-months as undetectable or <200 copies/mL. We used Rao-Scott chi-square tests to examine the association between non-persistence and sociodemographic, behavioral, clinical, and medication-related factors. We examined the association between non-persistence and sustained VS, stratified by adherence, and present prevalence ratios (PRs) with 95% confidence intervals (CIs). Reasons for non-persistence were assessed. Overall, 7% of patients reported non-persistence. Drug use, depression and medication side effects were associated with non-persistence (P < 0.01). Non-persistence was associated with the lack of sustained VS (PR: .66, CI:63-.70); this association did not differ by adherence level. However, VS was lower among the non-persistent/adherent compared with the persistent/non-adherent [51% (CI:47–54) versus 61% (CI:36–46), P < 0.01]. The most prevalent reason for non-persistence was treatment fatigue (38%). Though few persons in HIV care reported non-persistence, our findings suggest that non-persistence is associated with lack of sustained VS, regardless of adherence. Routine screening for non-persistence during clinical appointments and counseling for those at risk for non-persistence may help improve clinical outcomes.

KEYWORDS:

• HIV
• antiretroviral therapy
• persistence
• adherence
• viral load

Acknowledgements

We thank participating MMP providers, facilities, and project areas. We also acknowledge the contributions of the Clinical Outcomes Team and the Behavioral and Clinical Surveillance Branch at CDC and the MMP Project Area Group Members.

Disclosure statement

No potential conflict of interest was reported by the authors.

Declaration of interest statement

The authors declare no conflicts of interest.

Disclaimer

The findings and conclusion in this report are those of the authors and do not necessarily represent the views of the Centers for Disease Control and Prevention. Portions of the analysis were presented at the 10^th International Conference on HIV Treatment and Prevention Adherence in Miami, FL, USA in June 2015.

Source of support

Funding for the Medical Monitoring Project is provided by a cooperative agreement (PS09–937) from the Centers for Disease Control and Prevention.

Additional information

Funding

This work was supported by National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention: [Grant Number PS09-937].