Patient and Regimen Characteristics Associated with Self-Reported Nonadherence to Antiretroviral Therapy

BACKGROUND: Nonadherence to antiretroviral therapy (ARVT) is an important behavioral determinant of the success of ARVT. Nonadherence may lead to virological failure, and increases the risk of development of drug resistance. Understanding the prevalence of nonadherence and associated factors is important to inform secondary HIV prevention efforts. METHODOLOGY/PRINCIPAL FINDINGS: We used data from a cross-sectional interview study of persons with HIV conducted in 18 U.S. states from 2000-2004. We calculated the proportion of nonadherent respondents (took <95% of prescribed doses in the past 48 hours), and the proportion of doses missed. We used multivariate logistic regression to describe factors associated with nonadherence. Nine hundred and fifty-eight (16%) of 5,887 respondents reported nonadherence. Nonadherence was significantly (p<0.05) associated with black race and Hispanic ethnicity; age <40 years; alcohol or crack use in the prior 12 months; being prescribed >or=4 medications; living in a shelter or on the street; and feeling "blue" >or=14 of the past 30 days. We found weaker associations with having both male-male sex and injection drug use risks for HIV acquisition; being prescribed ARVT for >or=21 months; and being prescribed a protease inhibitor (PI)-based regimen not boosted with ritonavir. The median proportion of doses missed was 50%. The most common reasons for missing doses were forgetting and side effects. CONCLUSIONS/SIGNIFICANCE: Self-reported recent nonadherence was high in our study. Our data support increased emphasis on adherence in clinical settings, and additional research on how providers and patients can overcome barriers to adherence

Excess burden of depression among HIV-infected persons receiving medical care in the united states: data from the medical monitoring project and the behavioral risk factor surveillance system.

BackgroundWith increased life expectancy for HIV-infected persons, there is concern regarding comorbid depression because of its common occurrence and association with behaviors that may facilitate HIV transmission. Our objectives were to estimate the prevalence of current depression among HIV-infected persons receiving care and assess the burden of major depression, relative to that in the general population.Methods and findingsWe used data from the Medical Monitoring Project (MMP) and the Behavioral Risk Factors Surveillance System (BRFSS). The eight-item Patient Health Questionnaire was used to identify depression. To assess the burden of major depression among HIV-infected persons receiving care, we compared the prevalence of current major depression between the MMP and BRFSS populations using stratified analyses that simultaneously controlled for gender and, in turn, each of the potentially confounding demographic factors of age, race/ethnicity, education, and income. Each unadjusted comparison was summarized as a prevalence ratio (PR), and each of the adjusted comparisons was summarized as a standardized prevalence ratio (SPR). Among HIV-infected persons receiving care, the prevalence of a current episode of major depression and other depression, respectively, was 12.4% (95% CI: 11.2, 13.7) and 13.2% (95% CI: 12.0%, 14.4%). Overall, the PR comparing the prevalence of current major depression between HIV-infected persons receiving care and the general population was 3.1. When controlling for gender and each of the factors age, race/ethnicity, and education, the SPR (3.3, 3.0, and 2.9, respectively) was similar to the PR. However, when controlling for gender and annual household income, the SPR decreased to 1.5.ConclusionsDepression remains a common comorbidity among HIV-infected persons. The overall excess burden among HIV-infected persons receiving care is about three-times that among the general population and is associated with differences in annual household income between the two populations. Relevant efforts are needed to reduce this burden

Characteristics of HIV infected persons interviewed about adherence to currently prescribed antiretroviral therapy, number and proportion of nonadherent respondents, and logistic regression model of factors associated with nonadherence among 5,887 respondents to the Supplement to HIV/AIDS Surveillance Project, 18 US States, 2000 to 2004

<p>ARVT: antiretroviral therapy; PI: protease inhibitor; HAART: Highly active antiretroviral therapy.</p>*<p>Referent group is all other races</p>†<p>Referent group is ≥40 years</p>‡<p>Confidence interval excludes 1.0; lower bound is rounded down to 1.0.</p>§<p>Referent group is all other risks</p>∥<p>Referent group is all other places of residence</p>¶<p>Any use in the 12 months before the interview</p>**<p>Referent group is duration of ARVT treatment <21 months</p>††<p>Referent group is currently prescribed 1–3 drugs</p>‡‡<p>Referent group is any other prescribed regimen</p

Relative and standardized prevalence of major depression by gender and four demographic characteristics — Medical Monitoring Project (MMP), 2009 and Behavioral Risk Factor Surveillance System (BRFSS), 2006 and 2008.

<p>wgt. %  =  weighted %; SE  =  standard error; PR  =  prevalence ratio (unadjusted); SPR  =  standardized prevalence ratio; 95% CI = 95% confidence intervals.</p><p>Responses to the Eight-item Patient Health Questionnaire were used to define “major depression” according to criteria from the Diagnostic and Statistical Manual of Mental Disorders, 4^th Edition.</p

Self-reported characteristics of HIV-infected adults receiving medical care and general population adults in the United States who completed the Eight-item Patient Health Questionnaire depression scale — Medical Monitoring Project (MMP) 2009 and Behavioral Risk Factor Surveillance System (BRFSS), 2006 and 2008.

<p><i>*</i>Male-to-female or female-to-male; <b>^†</b>mutually exclusive race/ethnicity categories.</p><p>wgt. col%  =  weighted column %; 95% CI = 95% confidence intervals.</p