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Regimen-dependent variations in adherence to therapy and virological suppression in patients initiating protease inhibitor-based highly active antiretroviral therapy.
HIV Med. 2006 Jul; 7(5):311-6.HM

Abstract

OBJECTIVE

To examine differences among four protease inhibitor (PI)-based drug regimens in adherence to therapy and rate of achievement of virological suppression in a cohort of antiretroviral-naive patients initiating highly active antiretroviral therapy (HAART).

METHODS

Participants were antiretroviral-naive and were first dispensed combination therapy containing two nucleosides and a ritonavir (RTV)-boosted PI, or unboosted nelfinavir, between 1 January 2000 and 30 September 2003. Logistic regression analysis was used to examine associations between the prescribed PI and other baseline factors associated with being >90% adherent to therapy and then to determine the associations of prescribed drug regimen, adherence to therapy and baseline variables with the odds of achieving two consecutive viral loads of <500 HIV-1 RNA copies/mL. RESULTS A total of 385 subjects were available for analysis. Lopinavir (LPV)/RTV was prescribed for 168 patients (42% of total); 86 (22%) received indinavir (IDV)/RTV; 91 (24%) received nelfinavir (NFV) and 40 (10%) received saquinavir (SQV)/RTV. SQV/RTV-based HAART was associated with reduced adherence to therapy [odds ratio (OR)=0.40; 95% confidence interval (CI) 0.19-0.83]. In multivariate models, IDV/RTV (OR=0.45; 95% CI 0.22-0.92), SQV/RTV (OR=0.18; 95% CI 0.07-0.43) and NFV were associated with reduced odds of achieving virological suppression within 1 year in comparison to LPV/RTV-based therapy. For patients receiving NFV, adjusting for adherence (OR=0.73; 95% CI 0.36-1.47) rendered this association nonsignificant.

CONCLUSION

Patients prescribed IDV/RTV, NFV or SQV/RTV were less likely to achieve virological suppression on their first regimen compared with patients prescribed LPV/RTV. Reduced adherence to these therapies only partly explained these observed differences.

Authors+Show Affiliations

BC Centre for Excellence in HIV/AIDS, Vancouver, British Columbia, Canada. dmoore@cfenet.ubc.caNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Comparative Study
Journal Article
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

16945076

Citation

Moore, D M., et al. "Regimen-dependent Variations in Adherence to Therapy and Virological Suppression in Patients Initiating Protease Inhibitor-based Highly Active Antiretroviral Therapy." HIV Medicine, vol. 7, no. 5, 2006, pp. 311-6.
Moore DM, Hogg RS, Yip B, et al. Regimen-dependent variations in adherence to therapy and virological suppression in patients initiating protease inhibitor-based highly active antiretroviral therapy. HIV Med. 2006;7(5):311-6.
Moore, D. M., Hogg, R. S., Yip, B., Wood, E., Harris, M., & Montaner, J. S. (2006). Regimen-dependent variations in adherence to therapy and virological suppression in patients initiating protease inhibitor-based highly active antiretroviral therapy. HIV Medicine, 7(5), 311-6.
Moore DM, et al. Regimen-dependent Variations in Adherence to Therapy and Virological Suppression in Patients Initiating Protease Inhibitor-based Highly Active Antiretroviral Therapy. HIV Med. 2006;7(5):311-6. PubMed PMID: 16945076.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Regimen-dependent variations in adherence to therapy and virological suppression in patients initiating protease inhibitor-based highly active antiretroviral therapy. AU - Moore,D M, AU - Hogg,R S, AU - Yip,B, AU - Wood,E, AU - Harris,M, AU - Montaner,J S G, PY - 2006/9/2/pubmed PY - 2007/5/22/medline PY - 2006/9/2/entrez SP - 311 EP - 6 JF - HIV medicine JO - HIV Med. VL - 7 IS - 5 N2 - OBJECTIVE: To examine differences among four protease inhibitor (PI)-based drug regimens in adherence to therapy and rate of achievement of virological suppression in a cohort of antiretroviral-naive patients initiating highly active antiretroviral therapy (HAART). METHODS: Participants were antiretroviral-naive and were first dispensed combination therapy containing two nucleosides and a ritonavir (RTV)-boosted PI, or unboosted nelfinavir, between 1 January 2000 and 30 September 2003. Logistic regression analysis was used to examine associations between the prescribed PI and other baseline factors associated with being >90% adherent to therapy and then to determine the associations of prescribed drug regimen, adherence to therapy and baseline variables with the odds of achieving two consecutive viral loads of <500 HIV-1 RNA copies/mL. RESULTS A total of 385 subjects were available for analysis. Lopinavir (LPV)/RTV was prescribed for 168 patients (42% of total); 86 (22%) received indinavir (IDV)/RTV; 91 (24%) received nelfinavir (NFV) and 40 (10%) received saquinavir (SQV)/RTV. SQV/RTV-based HAART was associated with reduced adherence to therapy [odds ratio (OR)=0.40; 95% confidence interval (CI) 0.19-0.83]. In multivariate models, IDV/RTV (OR=0.45; 95% CI 0.22-0.92), SQV/RTV (OR=0.18; 95% CI 0.07-0.43) and NFV were associated with reduced odds of achieving virological suppression within 1 year in comparison to LPV/RTV-based therapy. For patients receiving NFV, adjusting for adherence (OR=0.73; 95% CI 0.36-1.47) rendered this association nonsignificant. CONCLUSION: Patients prescribed IDV/RTV, NFV or SQV/RTV were less likely to achieve virological suppression on their first regimen compared with patients prescribed LPV/RTV. Reduced adherence to these therapies only partly explained these observed differences. SN - 1464-2662 UR - https://www.unboundmedicine.com/medline/citation/16945076/Regimen_dependent_variations_in_adherence_to_therapy_and_virological_suppression_in_patients_initiating_protease_inhibitor_based_highly_active_antiretroviral_therapy_ L2 - https://doi.org/10.1111/j.1468-1293.2006.00381.x DB - PRIME DP - Unbound Medicine ER -