Abstract
OBJECTIVE:: To characterize the impact of longitudinal adherence on survival in drug-naive individuals starting currently recommended highly active antiretroviral therapy (HAART) regimens. METHODS:: Eligible study participants initiated HAART between January 2000 and November 2004 and were followed until November 2005 (N ≤ 903). HAART regimens contained efavirenz, nevirapine, or ritonavir-boosted atazanavir or lopinavir. Marginal structural modeling was used to address our objective. RESULTS:: The all-cause mortality was 11%. Individual adherence decreased significantly over time, with the mean adherence shifting from 79% within the first 6 months of starting HAART to 72% within the 24- to 30-month period (P value <0.01). Nonadherence over time (<95%) was strongly associated with higher risk of mortality (hazard ratio: 3.13; 95% confidence interval (CI): 1.95 to 5.05). Nonadherent (<95%) patients on nonnucleoside reverse transcriptase inhibitor (NNRTI)-based and boosted protease inhibitor-based regimens were, respectively, 3.61 times (95% CI: 2.15 to 6.06) and 3.25 times (95% CI: 1.63 to 6.49) more likely to die than adherent patients. Within the NNRTI-based regimens, nonadherent individuals on efavirenz were at a higher risk of mortality. CONCLUSIONS:: Incomplete adherence to modern HAART over time was strongly associated with increased mortality, and patients on efavirenz-based NNRTI therapies were particularly at a higher risk if nonadherent. These results highlight the need to develop further strategies to help sustain high levels of adherence on a long-term basis.
Original language | English (US) |
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Pages (from-to) | 529-536 |
Number of pages | 8 |
Journal | Journal of Acquired Immune Deficiency Syndromes |
Volume | 50 |
Issue number | 5 |
DOIs | |
State | Published - Apr 2009 |
Externally published | Yes |
Keywords
- Adherence
- Boosted PI
- HAART
- Marginal structural models
- Mortality
- NNRTI
ASJC Scopus subject areas
- Infectious Diseases
- Pharmacology (medical)