Antiretroviral
drug adherence is critical, and treatment should be
closely monitored for indications of HIV progression such as
a decrease in CD4-cell levels and an increase in viral
load, said Sabina De Geest of the University of Basel,
Switzerland. Using data from the Swiss HIV Cohort
Study, De Geest and colleagues sought to determine the
prevalence of self-reported antiretroviral adherence
and to explore the relationships among socioeconomic,
patient, and systematic factors related to adherence.
Data showed that
nearly one third of patients acknowledged missing at
least one dose of medicine in the four weeks prior to
completing the questionnaire, the researchers
reported. Around 15% said they missed at least two
doses, and 7.1% said they took less than 95% of prescribed
antiretroviral therapy doses.
Irrespective of
the definition of adherence used, patients who were
younger, lived alone, had been on previous anti-HIV drug
regimens, and those who received a boosted protease
inhibitor regimen were significantly more likely to
have not adhered to therapy in the past four weeks,
the researchers found. Those patients with optimal viral
suppression in the previous six months and those with
CD4-cell count increases of more than 50 cells per
microliter were considerably more likely to have
adhered to treatment.
"An interesting
finding of this study was that we observed a center
effect," De Geest noted. "Adherence ranged among centers
between 26.1% and 41.5%. This observed center effect
is a novel finding and suggests that system factors
related to how care is organized and provided also are
associated with nonadherence." (Reuters)