Factors associated with non-adherence to antiretroviral therapy in the SUN study

Abstract

Background. Adherence of 95% or greater to highly active combination antiretroviral therapy is generally considered necessary to achieve optimal virologic suppression in HIV-infected patients. Understanding factors associated with poor adherence is essential to improve patient compliance, maximize virologic suppression, and reduce morbidity and mortality.

Methods. We evaluated baseline data from 528 patients taking antiretrovirals, enrolled from March 2004 to June 2006, in a multicenter, longitudinal, prospective cohort study (the SUN study). Using multiple logistic regression, we examined independent risk factors for non-adherence, defined as reporting having missed one or more antiretroviral doses in the past three days on the baseline questionnaire.

Results. Of 528 participants (22% female, 28% black, median age 41 years, and median CD4 cell count 486 cells/mm³), 85 (16%) were non-adherent. In the final parsimonious multivariate model, factors independently associated with non-adherence included black race (adjusted odds ratio (aOR): 2.08, 95% confidence interval (CI): 1.20–3.60 vs. white race), being unemployed and looking for work (aOR: 2.03, 95% CI: 1.14–3.61 vs. all other employment categories), having been diagnosed with HIV ≥5 years ago (aOR: 1.95, 95% CI: 1.18–3.24 vs. being HIV-diagnosed <5 years ago), drinking three or more drinks per day (aOR: 1.73, 95% CI: 1.02–2.91 vs. drinking <3 drinks per day), and having not engaged in any aerobic exercise in the last 30 days (aOR: 2.13, 95% CI: 1.25–3.57).

Conclusion. Although the above factors may not be causally related to non-adherence, they might serve as proxies for identifying HIV-infected patients at greatest risk for non-adherence who may benefit from additional adherence support.

Keywords:

• adherence
• risk factors
• cART
• HAART

Acknowledgements

The SUN study investigators include John T. Brooks, Claudia Vellozzi, Lois Conley, and Tim Bush, Division of HIV/AIDS Prevention, NCHHSTP, CDC, Atlanta, GA; Kathleen Wood, Rose Baker, and Cheryl Akridge, Cerner Corporation, Vienna Virginia; John Hammer, Tara Kennedy, Barbara Widick, and Billie Thomas, Denver Infectious Disease Consultants, Inc., Denver, CO; Ken Lichtenstein and Cheryl Stewart, National Jewish Medical and Research Center, Denver, CO; Keith Henry, Jason Baker, Edie Gunderson, Miki Olson, and John Hall, Hennepin County Medical Center, Minneapolis, MN; Frank Rhame, Mark Olson, and Eve Austad, Abbott-Northwestern Hospital, Minneapolis, MN; Hal Martin, Meaghan Morton, and Cheri Murch, Park-Nicollet Institute, Minneapolis, MN; Charles Carpenter, Susan Cu-Uvin, Kenneth Mayer, Erna Milunka Kojic, Jennifer Florczyk, Sara Metzler, and Patricia D'Aiello, The Miraim Hospital, Providence, RI; E. Turner Overton, Lisa Kessels, Mariea Snell, Dorothea Dedeaux-Turner, Sara Hubert, Mike Klebert, and Kenneth Griffie, Washington University School of Medicine, St. Louis, MO.

The investigation followed the guidelines of the US Department of Health and Human Services regarding protection of human subjects. The study protocol was approved and renewed annually by each participating institutions’ ethical review board. All study participants provided written, informed consent. The financial support was Centers for Disease Control and Prevention Contract Nos. 200-2002-00610, 200-2002-00611, 200-2002-00612, 200-2002-00613, 200-2007-23633, 200-2007-23634, 200-2007-23635, and 200-2007-23636. This research was supported in part by an appointment to the Research Participation Program at the Centers for Disease Control and Prevention administered by the Oak Ridge Institute for Science and Education through an interagency agreement between the US Department of Energy and CDC. Prior Presentation was 2nd International Conference on HIV Treatment Adherence, Jersey City, NJ, March 2007; poster P-168. The findings and conclusions in this report are those of the authors and do not necessarily represent the official position of the Centers for Disease Control and Prevention.