1
|
Klein MB, Young J, Ortiz-Paredes D, Wang S, Walmsley S, Wong A, Martel-Laferrière V, Pick N, Conway B, Angel J, Baril JG, Fraser C, Lebouché B, Tan DHS, Sandre R, Trottier S, Peiris H, Jayaraman J, Singer J. Virological Outcomes After Switching to Abacavir/Lamivudine/Dolutegravir Combined with Adherence Support in People Living with HIV with Poor Adherence: A Phase IV, Multicentre Randomized Prospective Open Label Study (TriiADD-CTN 286). Patient Prefer Adherence 2022; 16:3267-3281. [PMID: 36536672 PMCID: PMC9759014 DOI: 10.2147/ppa.s379065] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/18/2022] [Accepted: 10/12/2022] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND Many people living with HIV struggle to consistently adhere to antiretroviral therapy, fail to achieve long-term virologic control and remain at risk for HIV-related disease progression, development of resistance and may transmit HIV infection to others. OBJECTIVE To determine if switching from current multi-tablet (curART) to single-tablet antiretroviral therapy (abacavir/lamivudine/dolutegravir; ABC/3TC/DTG), both combined with individualized adherence support, would improve HIV suppression in non-adherent vulnerable populations. METHODS TriiADD was an investigator-initiated randomized, multicentre, open label study. HIV+ adults with documented non-adherence on curART were randomized in a 1:1 ratio to immediately switch to ABC/3TC/DTG or to continue curART. Both arms received adherence support. The primary outcome was the proportion of participants in each arm with HIV RNA < 50 copies/mL 24 weeks after randomization. RESULTS In total, 50 people were screened and 27 randomized from 11 sites across Canada before the trial was stopped early due to slow recruitment. Participants were predominantly from ethnocultural communities, Indigenous people and/or had a history of injection drug use. The proportion achieving HIV RNA < 50 copies/mL at week 24 was 4/12 (33%) in the curART arm vs 7/13 (54%) in the ABC/3TC/DTG arm; median Bayesian risk difference, 5% (95% CrI, -17 to 28%) higher for those randomized to ABC/3TC/DTG. We encountered difficulties with recruitment of participants without prior drug resistance, retention despite intensive support, reliably measuring adherence and in overcoming entrenched adherence barriers. CONCLUSION Results of our trial are consistent with a slight improvement in viral suppression in a vulnerable population when a single tablet regimen is combined with patient-level adherence support. Beyond treatment simplicity and tolerability, tailored interventions addressing stigma and social determinants of health are still needed. The numerous challenges we encountered illustrate how randomised trials may not be the best approach for assessing adherence interventions in vulnerable populations.
Collapse
Affiliation(s)
- Marina B Klein
- Division of Infectious Diseases and Chronic Viral Illness Service, Department of Medicine, McGill University Health Centre, Montreal, Canada
- Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal, Canada
- Centre for Outcomes Research and Evaluation, Research Institute of the McGill University Health Centre, Montreal, Canada
- Canadian Institutes of Health Research, Canadian HIV Trials Network, Vancouver, Canada
- Correspondence: Marina B Klein, Division of Infectious Diseases and Chronic Viral Illness Service, McGill University Health Centre, 1001 Decarie Boulevard, D02.4110, Montréal, H4A 3J1, Canada, Tel +1-514-843-2090, Fax +1-514-843-2092, Email
| | - Jim Young
- Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal, Canada
| | - David Ortiz-Paredes
- Centre for Outcomes Research and Evaluation, Research Institute of the McGill University Health Centre, Montreal, Canada
| | - Shouao Wang
- Centre for Outcomes Research and Evaluation, Research Institute of the McGill University Health Centre, Montreal, Canada
| | - Sharon Walmsley
- Canadian Institutes of Health Research, Canadian HIV Trials Network, Vancouver, Canada
- University Health Network, University of Toronto, Toronto, Canada
| | - Alexander Wong
- Department of Medicine, University of Saskatchewan, Regina, Canada
| | - Valérie Martel-Laferrière
- Department of Microbiology and Infectious Diseases, Centre de recherche du Centre hospitalier de l’Université de Montréal, Montreal, Canada
| | - Neora Pick
- Department of Medicine, Division of Infectious Diseases, University of British Columbia, Vancouver, Canada
| | - Brian Conway
- Vancouver Infectious Diseases Centre, Vancouver, Canada
| | | | - Jean-Guy Baril
- Clinique de Médecine Urbaine du Quartier Latin, Montreal, Canada
| | - Chris Fraser
- Cool Aid Community Health Centre, Victoria, Canada
| | - Bertrand Lebouché
- Centre for Outcomes Research and Evaluation, Research Institute of the McGill University Health Centre, Montreal, Canada
- Department of Family Medicine, McGill University, Montreal, Canada
| | - Darrell H S Tan
- Toronto General Hospital Research Institute, University Health Network, Toronto, Canada
| | - Roger Sandre
- HAVEN Program, Health Sciences North, Sudbury, Canada
| | - Sylvie Trottier
- Centre de Recherche du CHU de Québec, Department of Microbiology, Infectiology and Immunology, Université Laval, Quebec, Canada
| | - Hansi Peiris
- Centre for Outcomes Research and Evaluation, Research Institute of the McGill University Health Centre, Montreal, Canada
| | - Jayamarx Jayaraman
- Canadian Institutes of Health Research, Canadian HIV Trials Network, Vancouver, Canada
| | - Joel Singer
- Canadian Institutes of Health Research, Canadian HIV Trials Network, Vancouver, Canada
| | | |
Collapse
|
2
|
Benoit AC, Burchell AN, O'Brien KK, Raboud J, Gardner S, Light L, Beaver K, Cotnam J, Conway T, Price C, Rourke SB, Rueda S, Hart TA, Loutfy M. Examining the association between stress and antiretroviral therapy adherence among women living with HIV in Toronto, Ontario. HIV Res Clin Pract 2020; 21:45-55. [PMID: 32419657 DOI: 10.1080/25787489.2020.1763711] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
BACKGROUND We aimed to identify the association between stress and antiretroviral therapy (ART) adherence among women in HIV care in Toronto, Ontario participating in the Ontario HIV Treatment Network Cohort Study (OCS) between 2007 and 2012. MATERIALS AND METHODS We conducted cross-sectional analyses with women on ART completing the AIDS Clinical Trial Group (ACTG) Adherence Questionnaire. Data closest to, or at the last completed interview, were collected from medical charts, through record linkage with Public Health Ontario Laboratories, and from a standardized self-reported questionnaire comprised of socio-demographic and psycho-socio-behavioral measures (Center for Epidemiologic Studies Depression Scale (CES-D), Alcohol Use Disorders Identification Test (AUDIT)), and stress measures (National Population Health Survey). Logistic regression was used to quantify associations with optimal adherence (≥95% adherence defined as missing ≤ one dose of ART in the past 4 weeks). RESULTS Among 307 women, 65.5% had optimal adherence. Women with suboptimal compared to optimal adherence had higher median total stress scores (6.0 [interquartile range (IQR): 3.0-8.1] vs. 4.1 [IQR: 2.0-7.1], p = 0.001), CES-D scores (16 [IQR: 6-28] vs. 12 [IQR: 3-22], p = 0.008) and reports of hazardous and harmful alcohol use (31.1% vs. 17.9%, p = 0.008). In our multivariable model, we found an increased likelihood of optimal adherence with the absence of hazardous and harmful alcohol use (Adjusted Odds Ratio (AOR)=2.20, 95% confidence interval (CI): 1.12-4.32) and a decreased likelihood of optimal adherence with more self-reported stress (AOR = 0.56, 95% CI: 0.33-0.94). CONCLUSIONS Interventions supporting optimal ART adherence should address stress and include strategies to reduce or eliminate hazardous and harmful alcohol use for women living with HIV.
Collapse
Affiliation(s)
- Anita C Benoit
- Women's College Research Institute, Women's College Hospital, University of Toronto, Toronto, ON, Canada.,Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
| | - Ann N Burchell
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada.,Department of Family and Community Medicine, Centre for Urban Health Solutions, Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, ON, Canada
| | - Kelly K O'Brien
- Department of Physical Therapy, University of Toronto, Toronto, ON, Canada.,Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada.,Rehabilitation Sciences Institute, University of Toronto, Toronto, ON, Canada
| | - Janet Raboud
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada.,Toronto General Hospital Research Institute, University Health Network, Toronto, ON, Canada
| | - Sandra Gardner
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada.,Baycrest Health Sciences, Kunin-Lunenfeld Centre for Applied Research and Evaluation (KL-CARE), Toronto, ON, Canada
| | - Lucia Light
- Ontario HIV Treatment Network, Toronto, ON, Canada
| | - Kerrigan Beaver
- Women's College Research Institute, Women's College Hospital, University of Toronto, Toronto, ON, Canada
| | - Jasmine Cotnam
- Women's College Research Institute, Women's College Hospital, University of Toronto, Toronto, ON, Canada
| | - Tracey Conway
- Project Community Advisory Committee, Ontario HIV Treatment Network Cohort Study, Ontario, Canada
| | - Colleen Price
- Project Community Advisory Committee, Ontario HIV Treatment Network Cohort Study, Ontario, Canada
| | - Sean B Rourke
- Centre for Urban Health Solutions, Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, Ontario, M5B 1W8, Canada.,Department of Psychiatry, University of Toronto, Toronto, ON, Canada
| | - Sergio Rueda
- Department of Psychiatry, University of Toronto, Toronto, ON, Canada.,Institute for Mental Health Policy Research, Centre for Addiction and Mental Health, Toronto, ON, Canada
| | - Trevor A Hart
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada.,Department of Psychology, Ryerson University, Toronto, ON, Canada
| | - Mona Loutfy
- Women's College Research Institute, Women's College Hospital, University of Toronto, Toronto, ON, Canada.,Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada.,Faculty of Medicine, University of Toronto, Toronto, ON, Canada.,Department of Medicine, Women's College Research Institute, Women's College Hospital, Toronto, ON, Canada
| | | |
Collapse
|
3
|
Revuelta-Herrero JL, Chamorro-de-Vega E, Rodríguez-González CG, Alonso R, Herranz-Alonso A, Sanjurjo-Sáez M. Effectiveness, Safety, and Costs of a Treatment Switch to Dolutegravir Plus Rilpivirine Dual Therapy in Treatment-Experienced HIV Patients. Ann Pharmacother 2017; 52:11-18. [PMID: 28836468 DOI: 10.1177/1060028017728294] [Citation(s) in RCA: 37] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND Evidence about the use of dolutegravir (DTG) and rilpivirine (RPV) as an antiretroviral therapy (ART) in treatment-experienced patients is scarce. OBJECTIVE To explore the effectiveness, safety, and costs of switching to a DTG plus RPV regimen in this population. METHODS This observational, prospective study included all treatment-experienced patients who switched to DTG plus RPV between November 2014 and July 2016. Patients were excluded if resistance mutations to integrase inhibitors or RPV were found. The effectiveness endpoint was the proportion of patients who achieved virological suppression (viral load [VL] <50 copies/mL) at week 48 (W48). Safety (incidence of adverse events leading to discontinuation and laboratory abnormalities), adherence, and costs were analyzed. RESULTS A total of 35 patients were included, and 91.4% were virologically suppressed at baseline. Patients were treated with ART for a median of 14 years (interquartile range = 7-20). At W48, 91.4% of patients were virologically suppressed (95% CI = 77.0-98.2). Two of the 3 patients not suppressed at baseline achieved undetectable VL at W48, and 2 patients discontinued DTG plus RPV (intolerance and a drug-drug interaction). None of the virologically suppressed patients at baseline showed virological rebound through W48. There were no significant changes in lipid, liver, and renal profiles. The proportion of patients with an ART adherence >90% increased from 65.6% to 93.8% ( P = 0.004). The annual per-patient ART costs dropped by €665 ( P = 0.265). CONCLUSIONS Switching to DTG plus RPV seems to be an effective and safe strategy. Significant improvements in patients' adherence and costs were achieved.
Collapse
Affiliation(s)
- José Luis Revuelta-Herrero
- 1 Pharmacy Department. Hospital General Universitario Gregorio Marañón. Instituto de Investigación Sanitaria Hospital Gregorio Marañón (IiSGM), Madrid, Spain
| | - Esther Chamorro-de-Vega
- 1 Pharmacy Department. Hospital General Universitario Gregorio Marañón. Instituto de Investigación Sanitaria Hospital Gregorio Marañón (IiSGM), Madrid, Spain
| | - Carmen Guadalupe Rodríguez-González
- 1 Pharmacy Department. Hospital General Universitario Gregorio Marañón. Instituto de Investigación Sanitaria Hospital Gregorio Marañón (IiSGM), Madrid, Spain
| | - Roberto Alonso
- 2 Microbiology and Infectious Diseases Department. Hospital General Universitario Gregorio Marañón. Instituto de Investigación Sanitaria Hospital Gregorio Marañón (IiSGM), Madrid, Spain
| | - Ana Herranz-Alonso
- 1 Pharmacy Department. Hospital General Universitario Gregorio Marañón. Instituto de Investigación Sanitaria Hospital Gregorio Marañón (IiSGM), Madrid, Spain
| | - María Sanjurjo-Sáez
- 1 Pharmacy Department. Hospital General Universitario Gregorio Marañón. Instituto de Investigación Sanitaria Hospital Gregorio Marañón (IiSGM), Madrid, Spain
| |
Collapse
|
4
|
Boretzki J, Wolf E, Wiese C, Noe S, Balogh A, Meurer A, Krznaric I, Zink A, Lersch C, Spinner CD. Highly specific reasons for nonadherence to antiretroviral therapy: results from the German adherence study. Patient Prefer Adherence 2017; 11:1897-1906. [PMID: 29184394 PMCID: PMC5687417 DOI: 10.2147/ppa.s141762] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND Reasons for and frequency of nonadherence to antiretroviral therapy (ART) may have changed due to pharmacological improvements. In addition, the importance of known non-pharmacologic reasons for nonadherence is unclear. METHODS We performed a cross-sectional, noninterventional, multicenter study to identify current reasons for nonadherence. Patients were categorized by physicians into the following adherence groups: good, unstable, or poor adherence. Co-variables of interest included age, sex, time since HIV diagnosis, ART duration, current ART regimen, HIV transmission route, comorbidity, HIV-1 RNA viral load (VL), and CD4 cell count. Patients self-reported the number of missed doses and provided their specific reasons for nonadherent behavior. Statistical analyses were performed using Fisher's extended exact test, Kruskal-Wallis test, and logistic regression models. RESULTS Our study assessed 215 participants with good (n=162), unstable (n=36), and poor adherence (n=17). Compared to patients with good adherence, patients with unstable and poor adherence reported more often to have missed at least one dose during the last week (good 11% vs unstable 47% vs poor 63%, p<0.001). Physicians' adherence assessment was concordant with patients' self-reports of missed doses during the last week (no vs one or more) in 81% cases. Similarly, we found a strong association of physicians' assessment with viral suppression. Logistic regression analysis showed that "reduced adherence" - defined as unstable or poor - was significantly associated with patients <30 years old, intravenous drug use, history of acquired immune deficiency syndrome (AIDS), and psychiatric disorders (p<0.05). Univariate analyses showed that specific reasons, such as questioning the efficacy/dosing of ART, HIV stigma, interactive toxicity beliefs regarding alcohol and/or party drugs, and dissatisfaction with regimen complexity, correlated with unstable or poor adherence (p<0.05). CONCLUSION Identification of factors associated with poor adherence helps in identifying patients with a higher risk for nonadherence. Reasons for nonadherence should be directly addressed in every patient, because they are common and constitute possible adherence intervention points.
Collapse
Affiliation(s)
- Johanna Boretzki
- Department of Medicine II, University Hospital Klinikum rechts der Isar, Munich
- German Center for Infection Research, Partner Site Munich
- Correspondence: Johanna Boretzki, Department of Medicine II, University Hospital Klinikum rechts der Isar, Ismaninger Street 22, 81675 Munich, Germany, Tel +49 89 4140 5236, Fax +49 89 4140 7555, Email
| | | | - Carmen Wiese
- MVZ Karlsplatz, HIV Clinical Care Center, Munich
| | | | | | - Anja Meurer
- Center for Infectiology and Internal Medicine, Munich
| | | | - Alexander Zink
- Department of Dermatology and Allergology, University Hospital Klinikum rechts der Isar, Munich, Germany
| | - Christian Lersch
- Department of Medicine II, University Hospital Klinikum rechts der Isar, Munich
| | - Christoph D Spinner
- Department of Medicine II, University Hospital Klinikum rechts der Isar, Munich
- German Center for Infection Research, Partner Site Munich
| |
Collapse
|
5
|
Abstract
Un tratamiento médico eficaz con un compromiso ininterrumpido en el cuidado es crítico para mejorar la supervivencia y la calidad de vida de los pacientes infectados con el virus de la inmunodeficiencia humana (VIH). Objetivos: se han llevado a cabo múltiples intervenciones conductuales para promover comportamientos de adherencia. Sin embargo, la adhesión a los medicamentos contra el VIH y las citas médicas siguen siendo un tema de preocupación mundial. Método: el modelo de promoción de la salud (HPM) es una adaptación de enfermería del modelo de creencias de salud. El HPM se centra en características y experiencias individuales, así como cogniciones y resultados específicos del comportamiento. La integración del HPM en el abordaje de los comportamientos de adherencia podría ser uno de los pilares del éxito en el cambio del comportamiento de la salud. Resultados: una búsqueda en la literatura no mostró ningún estudio que aplicó el HPM en los estudios de comportamiento de adherencia realizados entre las poblaciones infectadas por el VIH. Conclusión: este artículo presenta al lector la disponibilidad de las actuales intervenciones de adherencia-comportamiento y estrategias que se alinean con los componentes del modelo HPM. Además, propone la necesidad de que los miembros del equipo de tratamiento médico adopten el HPM en la práctica clínica actual con el fin de abordar eficazmente los problemas de comportamiento de adherencia.
Collapse
|
6
|
Biagi M, Badowski ME, Chiampas T, Young J, Patel M, Vaughn P. Co-administration of elvitegravir/cobicistat/tenofovir disoproxil fumarate/emtricitabine and atazanavir in treatment-experienced HIV patients. Int J STD AIDS 2016; 28:766-772. [PMID: 27587601 DOI: 10.1177/0956462416666440] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
We report the use of elvitegravir 150 mg/cobicistat 150 mg/tenofovir disoproxil fumarate 300 mg/emtricitabine 200 mg (EVG/COBI/TDF/FTC) once daily, in addition to once-daily atazanavir (ATV) 300 mg, in treatment-experienced patients with human immunodeficiency virus (HIV). Due to limited data available on the co-administration of these agents, our objective was to evaluate and monitor safety and efficacy of this regimen in patients who developed resistance or intolerance to conventional antiretroviral therapy (ART). This short report included offenders incarcerated in the Illinois Department of Corrections who were ≥18 years, HIV-infected, had documented antiretroviral resistance, and received EVG/COBI/TDF/FTC + ATV once daily. Based on previous ART, resistance patterns and current medications, seven patients were initiated on once-daily therapy consisting of EVG/COBI/TDF/FTC and ATV. Due to extensive resistance, two of the seven patients were also started on abacavir (ABC) 600 mg daily in addition to EVG/COBI/TDF/FTC and ATV. Of the seven patients, one had ART changed due to concerns of resistance based on a genotype, one experienced a decline in renal function that warranted a change in therapy, and one is currently virologically suppressed on a combination of EVG/COBI/TDF/FTC, ATV, and ABC. The remaining four patients remain virologically suppressed on EVG/COBI/TDF/FTC + ATV. Therapy consisting of EVG/COBI/TDF/FTC and ATV may be a viable option for some treatment-experienced HIV-infected patients. Further studies evaluating the safety, efficacy, and pharmacokinetics of this therapy are warranted, given the lack of information currently available.
Collapse
Affiliation(s)
- M Biagi
- 1 Department of Pharmacy Practice, College of Pharmacy, University of Illinois at Chicago, Chicago, IL, USA
| | - M E Badowski
- 1 Department of Pharmacy Practice, College of Pharmacy, University of Illinois at Chicago, Chicago, IL, USA
| | - T Chiampas
- 1 Department of Pharmacy Practice, College of Pharmacy, University of Illinois at Chicago, Chicago, IL, USA
| | - J Young
- 2 Section of Infectious Diseases, College of Medicine, University of Illinois at Chicago, Chicago, IL, USA
| | - M Patel
- 2 Section of Infectious Diseases, College of Medicine, University of Illinois at Chicago, Chicago, IL, USA
| | - P Vaughn
- 3 Department of Medicine, University of Illinois at Chicago, Chicago, IL, USA
| |
Collapse
|
7
|
Gross IM, Hosek S, Richards MH, Fernandez MI. Predictors and Profiles of Antiretroviral Therapy Adherence Among African American Adolescents and Young Adult Males Living with HIV. AIDS Patient Care STDS 2016; 30:324-38. [PMID: 27410496 PMCID: PMC4948258 DOI: 10.1089/apc.2015.0351] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Adherence to antiretroviral therapy (ART) is crucial for thwarting HIV disease progression and reducing secondary HIV transmission, yet youth living with HIV (YLH) struggle with adherence. The highest rates of new HIV infections in the United States occur in young African American men. A sample of 387 HIV-positive young African American males on ART was selected from a cross-sectional assessment of (YLH) receiving medical care within the Adolescent Trials Network for HIV/AIDS Interventions (ATN) from 2010 to 2012 (12-24 years old, median 22.00, SD 2.08). Participants completed self-reported adherence, demographic, health, and psychosocial measures. Sixty-two percent self-reported 100% ART adherence. Optimal data analysis identified frequency of cannabis use during the past 3 months as the strongest independent predictor of adherence, yielding moderate effect strength sensitivity (ESS) = 27.1, p < 0.001. Among participants with infrequent cannabis use, 72% reported full adherence; in contrast, only 45% of participants who used cannabis frequently reported full adherence. Classification tree analysis (CTA) was utilized to improve classification accuracy and to identify the pathways of ART adherence and nonadherence. The CTA model evidenced a 38% improvement above chance for correctly classifying participants as ART adherent or nonadherent. Participants most likely to be adherent were those with low psychological distress and minimal alcohol use (82% were adherent). Participants least likely to be adherent were those with higher psychological distress and engaged in weekly cannabis use (69% were nonadherent). Findings suggest multiple profiles of ART adherence for young African American males living with HIV and argue for targeted psychosocial interventions.
Collapse
Affiliation(s)
- Israel Moses Gross
- 1 Department of Psychiatry, John H. Stroger Hospital of Cook County , Chicago, Illinois
| | - Sybil Hosek
- 1 Department of Psychiatry, John H. Stroger Hospital of Cook County , Chicago, Illinois
| | | | | |
Collapse
|
8
|
Goldman DP, Juday T, Linthicum MT, Rosenblatt L, Seekins D. The prospect of a generation free of HIV may be within reach if the right policy decisions are made. Health Aff (Millwood) 2016; 33:428-33. [PMID: 24590941 DOI: 10.1377/hlthaff.2013.1280] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Scientific advances have transformed HIV treatment and prevention, leading to the adoption of an approach that emphasizes broad testing and antiretroviral treatment at earlier stages in the disease, called "test and treat." In addition to clinical benefits, early treatment generates considerable social and economic value. These changes raise the prospect that for the first time since the 1980s, an entire generation might be free of HIV. However, achieving such a goal will require continued scientific advances and the presence of policies and programs to ensure that people living with HIV/AIDS have access to health care and adhere to treatment regimens. This article explores the opportunities and challenges that the Affordable Care Act (ACA) presents for people living with HIV/AIDS and discusses how the act's various components might interact with existing support for people with HIV/AIDS, such as the Ryan White Program. As the ACA's reforms proceed, coordinated state and federal programs must make smart policy choices so that critical access to and affordability of comprehensive care are maintained in the fight against HIV/AIDS.
Collapse
|
9
|
Socioeconomic status and response to antiretroviral therapy in high-income countries: a literature review. AIDS 2016; 30:1147-62. [PMID: 26919732 DOI: 10.1097/qad.0000000000001068] [Citation(s) in RCA: 44] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
It has been shown that socioeconomic factors are associated with the prognosis of several chronic diseases; however, there is no recent systematic review of their effect on HIV treatment outcomes. We aimed to review the evidence regarding the existence of an association of socioeconomic status with virological and immunological response to antiretroviral therapy (ART). We systematically searched the current literature using the database PubMed. We identified and summarized original research studies in high-income countries that assessed the association between socioeconomic factors (education, employment, income/financial status, housing, health insurance, and neighbourhood-level socioeconomic factors) and virological response, immunological response, and ART nonadherence among people with HIV-prescribed ART. A total of 48 studies met the inclusion criteria (26 from the United States, six Canadian, 13 European, and one Australian), of which 14, six, and 35 analysed virological, immunological, and ART nonadherence outcomes, respectively. Ten (71%), four (67%), and 23 (66%) of these studies found a significant association between lower socioeconomic status and poorer response, and none found a significant association with improved response. Several studies showed that adjustment for nonadherence attenuated the association between socioeconomic status and ART response. Our review provides strong support that socioeconomic disadvantage is associated with poorer response to ART. However, most studies have been conducted in settings such as the United States without universal free healthcare access. Further study in settings with free access to ART could help assess the impact of socioeconomic status on ART outcomes and the mechanisms by which it operates.
Collapse
|
10
|
Implementation and Operational Research: Engagement in HIV Care Among Persons Enrolled in a Clinical HIV Cohort in Ontario, Canada, 2001-2011. J Acquir Immune Defic Syndr 2015; 70:e10-9. [PMID: 26322672 PMCID: PMC4623844 DOI: 10.1097/qai.0000000000000690] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Supplemental Digital Content is Available in the Text. Ensuring that people living with HIV are accessing and staying in care is vital to achieving optimal health outcomes including antiretroviral therapy (ART) success. We sought to characterize engagement in HIV care among participants of a large clinical cohort in Ontario, Canada, from 2001 to 2011.
Collapse
|
11
|
Single Tablet Regimen Usage and Efficacy in the Treatment of HIV Infection in Australia. AIDS Res Treat 2015; 2015:570316. [PMID: 26550490 PMCID: PMC4621333 DOI: 10.1155/2015/570316] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2015] [Accepted: 09/20/2015] [Indexed: 12/02/2022] Open
Abstract
Single tablet regimens (STRs) for HIV infection improve patient satisfaction, quality of life, medication adherence, and virological suppression compared to multitablet regimens (MTRs). This is the first study assessing STR uptake and durability in Australia. This retrospective audit of all patients receiving an STR (n = 299) at a large Sydney HIV clinic (January 2012–December 2013) assessed patient demographics, treatment prior to STR, HIV RNA load and CD4 during MTR and STR dosing, and reasons for STR switch. 206 patients switched from previous antiretroviral treatment to an STR, of which 88% switched from an MTR. Reasons for switching included desire to simplify treatment (57%), reduced side effects or toxicity (18%), and cost-saving for the patient. There was no switching for virological failure. Compared to when on an MTR, patients switching to an STR had significantly lower HIV RNA counts (p < 0.001) and significantly higher CD4 counts (p < 0.001). The discontinuation rate from STR was very low and all patients who switched to an STR maintained virological suppression throughout the study duration, although the study is limited by the absence of a control group.
Collapse
|
12
|
Piana C, Zhao W, Adkison K, Burger D, Jacqz-Aigrain E, Danhof M, Della Pasqua O. A model-based approach for the evaluation of once daily dosing of lamivudine in HIV-infected children. Br J Clin Pharmacol 2015; 77:852-60. [PMID: 24118047 DOI: 10.1111/bcp.12246] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2013] [Accepted: 08/28/2013] [Indexed: 01/11/2023] Open
Abstract
AIM Little attention has been paid to the effects of compliance and prescription practice on treatment outcome in HIV-infected children. In this context, an evaluation of the role of covariates on pharmacokinetics is required to establish the impact of differences in dosing regimens. Here we investigate whether a once daily dosing regimen of lamivudine provides comparable exposure to the currently approved paediatric regimen. METHODS A hypothetical group of 180 patients between 3 months and 12 years old was used to evaluate the impact of body weight on systemic exposure to lamivudine. Simulation scenarios were evaluated using AUC and Cmax as parameters of interest. The analysis was performed using a population pharmacokinetic model previously implemented in nonmem v.6.2. RESULTS The simulations show that once daily dosing of lamivudine yields comparable exposure to historical values observed in children and adults, both for liquid and solid dosage forms. Simulated steady-state AUC(0-24 h) and Cmax values after once daily doses ranged respectively from 9.9 mg l⁻¹ h and 1.9 mg l⁻¹ for children lighter than 14 kg to 13.75 mg l⁻¹ h and 3.0 mg l⁻¹ for children heavier than 30 kg. These values are comparable or higher than historical values observed after once daily dosing in children and adults. CONCLUSIONS Our findings illustrate how dosing regimens can be evaluated taking into account the effects of developmental growth on drug disposition. Most importantly, they suggest that the reduction in dosing frequency to once daily leads to comparable lamivudine exposure, as observed after administration of a twice daily dosing regimen.
Collapse
Affiliation(s)
- Chiara Piana
- LACDR, Division of Pharmacology, Leiden University, Leiden, The Netherlands
| | | | | | | | | | | | | |
Collapse
|
13
|
A mechanistic theory to explain the efficacy of antiretroviral therapy. Nat Rev Microbiol 2014; 12:772-80. [PMID: 25263222 DOI: 10.1038/nrmicro3351] [Citation(s) in RCA: 49] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
In the early years of the AIDS epidemic, a diagnosis of HIV-1 infection was equivalent to a death sentence. The development of combination antiretroviral therapy (cART) in the 1990s to combat HIV-1 infection was one of the most impressive achievements of medical science. Today, patients who are treated early with cART can expect a near-normal lifespan. In this Opinion article, we propose a fundamental theory to explain the mechanistic basis of cART and why it works so well, including a model to assess and predict the efficacy of antiretroviral drugs alone or in combination.
Collapse
|
14
|
Langebeek N, Gisolf EH, Reiss P, Vervoort SC, Hafsteinsdóttir TB, Richter C, Sprangers MAG, Nieuwkerk PT. Predictors and correlates of adherence to combination antiretroviral therapy (ART) for chronic HIV infection: a meta-analysis. BMC Med 2014; 12:142. [PMID: 25145556 PMCID: PMC4148019 DOI: 10.1186/preaccept-1453408941291432] [Citation(s) in RCA: 166] [Impact Index Per Article: 16.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/08/2014] [Accepted: 08/01/2014] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND Adherence to combination antiretroviral therapy (ART) is a key predictor of the success of human immunodeficiency virus (HIV) treatment, and is potentially amenable to intervention. Insight into predictors or correlates of non-adherence to ART may help guide targets for the development of adherence-enhancing interventions. Our objective was to review evidence on predictors/correlates of adherence to ART, and to aggregate findings into quantitative estimates of their impact on adherence. METHODS We searched PubMed for original English-language papers, published between 1996 and June 2014, and the reference lists of all relevant articles found. Studies reporting on predictors/correlates of adherence of adults prescribed ART for chronic HIV infection were included without restriction to adherence assessment method, study design or geographical location. Two researchers independently extracted the data from the same papers. Random effects models with inverse variance weights were used to aggregate findings into pooled effects estimates with 95% confidence intervals. The standardized mean difference (SMD) was used as the common effect size. The impact of study design features (adherence assessment method, study design, and the United Nations Human Development Index (HDI) of the country in which the study was set) was investigated using categorical mixed effects meta-regression. RESULTS In total, 207 studies were included. The following predictors/correlates were most strongly associated with adherence: adherence self-efficacy (SMD = 0.603, P = 0.001), current substance use (SMD = -0.395, P = 0.001), concerns about ART (SMD = -0.388, P = 0.001), beliefs about the necessity/utility of ART (SMD = 0.357, P = 0.001), trust/satisfaction with the HIV care provider (SMD = 0.377, P = 0.001), depressive symptoms (SMD = -0.305, P = 0.001), stigma about HIV (SMD = -0.282, P = 0.001), and social support (SMD = 0.237, P = 0.001). Smaller but significant associations were observed for the following being prescribed a protease inhibitor-containing regimen (SMD = -0.196, P = 0.001), daily dosing frequency (SMD = -0.193, P = 0.001), financial constraints (SMD -0.187, P = 0.001) and pill burden (SMD = -0.124, P = 0.001). Higher trust/satisfaction with the HIV care provider, a lower daily dosing frequency, and fewer depressive symptoms were more strongly related with higher adherence in low and medium HDI countries than in high HDI countries. CONCLUSIONS These findings suggest that adherence-enhancing interventions should particularly target psychological factors such as self-efficacy and concerns/beliefs about the efficacy and safety of ART. Moreover, these findings suggest that simplification of regimens might have smaller but significant effects.
Collapse
Affiliation(s)
- Nienke Langebeek
- />Department of Internal Medicine, Rijnstate Hospital, Wagnerlaan 55, Arnhem, 6815 AD Netherlands
- />Department of Medical Psychology, Academic Medical Center, Meibergdreef 9, Amsterdam, 1105 AZ Netherlands
| | - Elizabeth H Gisolf
- />Department of Internal Medicine, Rijnstate Hospital, Wagnerlaan 55, Arnhem, 6815 AD Netherlands
| | - Peter Reiss
- />Division of Infectious Diseases, and Department of Global Health, Amsterdam Institute for Global Health and Development, Academic Medical Center, Meibergdreef 9, Amsterdam, 1105 AZ Netherlands
- />Stichting HIV Monitoring, Meibergdreef 9, Amsterdam, 1105 AZ Netherlands
| | - Sigrid C Vervoort
- />Department of Infectious Diseases, University Medical Center, Heidelberglaan 100, Utrecht, 3584 CX Netherlands
| | - Thóra B Hafsteinsdóttir
- />Department of Rehabilitation, Nursing Science and Sports medicine, University Medical Center, Heidelberglaan 100, Utrecht, 3584 CX Netherlands
| | - Clemens Richter
- />Department of Internal Medicine, Rijnstate Hospital, Wagnerlaan 55, Arnhem, 6815 AD Netherlands
| | - Mirjam AG Sprangers
- />Department of Medical Psychology, Academic Medical Center, Meibergdreef 9, Amsterdam, 1105 AZ Netherlands
| | - Pythia T Nieuwkerk
- />Department of Medical Psychology, Academic Medical Center, Meibergdreef 9, Amsterdam, 1105 AZ Netherlands
- />Department of Medical Psychology (J3-219-1), Academic Medical Center, Amsterdam, 1100 DE Netherlands
| |
Collapse
|
15
|
Langebeek N, Gisolf EH, Reiss P, Vervoort SC, Hafsteinsdóttir TB, Richter C, Sprangers MAG, Nieuwkerk PT. Predictors and correlates of adherence to combination antiretroviral therapy (ART) for chronic HIV infection: a meta-analysis. BMC Med 2014. [PMID: 25145556 PMCID: PMC4148019 DOI: 10.1186/s12916-014-0142-1] [Citation(s) in RCA: 252] [Impact Index Per Article: 25.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
Background Adherence to combination antiretroviral therapy (ART) is a key predictor of the success of human immunodeficiency virus (HIV) treatment, and is potentially amenable to intervention. Insight into predictors or correlates of non-adherence to ART may help guide targets for the development of adherence-enhancing interventions. Our objective was to review evidence on predictors/correlates of adherence to ART, and to aggregate findings into quantitative estimates of their impact on adherence. Methods We searched PubMed for original English-language papers, published between 1996 and June 2014, and the reference lists of all relevant articles found. Studies reporting on predictors/correlates of adherence of adults prescribed ART for chronic HIV infection were included without restriction to adherence assessment method, study design or geographical location. Two researchers independently extracted the data from the same papers. Random effects models with inverse variance weights were used to aggregate findings into pooled effects estimates with 95% confidence intervals. The standardized mean difference (SMD) was used as the common effect size. The impact of study design features (adherence assessment method, study design, and the United Nations Human Development Index (HDI) of the country in which the study was set) was investigated using categorical mixed effects meta-regression. Results In total, 207 studies were included. The following predictors/correlates were most strongly associated with adherence: adherence self-efficacy (SMD = 0.603, P = 0.001), current substance use (SMD = -0.395, P = 0.001), concerns about ART (SMD = -0.388, P = 0.001), beliefs about the necessity/utility of ART (SMD = 0.357, P = 0.001), trust/satisfaction with the HIV care provider (SMD = 0.377, P = 0.001), depressive symptoms (SMD = -0.305, P = 0.001), stigma about HIV (SMD = -0.282, P = 0.001), and social support (SMD = 0.237, P = 0.001). Smaller but significant associations were observed for the following being prescribed a protease inhibitor-containing regimen (SMD = -0.196, P = 0.001), daily dosing frequency (SMD = -0.193, P = 0.001), financial constraints (SMD -0.187, P = 0.001) and pill burden (SMD = -0.124, P = 0.001). Higher trust/satisfaction with the HIV care provider, a lower daily dosing frequency, and fewer depressive symptoms were more strongly related with higher adherence in low and medium HDI countries than in high HDI countries. Conclusions These findings suggest that adherence-enhancing interventions should particularly target psychological factors such as self-efficacy and concerns/beliefs about the efficacy and safety of ART. Moreover, these findings suggest that simplification of regimens might have smaller but significant effects. Electronic supplementary material The online version of this article (doi:10.1186/s12916-014-0142-1) contains supplementary material, which is available to authorized users.
Collapse
Affiliation(s)
| | | | | | | | | | | | | | - Pythia T Nieuwkerk
- Department of Medical Psychology, Academic Medical Center, Meibergdreef 9, Amsterdam 1105, AZ, Netherlands.
| |
Collapse
|
16
|
Tseng A, Szadkowski L, Walmsley S, Salit I, Raboud J. Association of Age With Polypharmacy and Risk of Drug Interactions With Antiretroviral Medications in HIV-Positive Patients. Ann Pharmacother 2013; 47:1429-39. [DOI: 10.1177/1060028013504075] [Citation(s) in RCA: 79] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023] Open
Affiliation(s)
- Alice Tseng
- Toronto General Hospital, University Health Network, ON, Canada
- University of Toronto, ON, Canada
| | - Leah Szadkowski
- Toronto General Research Institute, University Health Network, ON, Canada
| | - Sharon Walmsley
- Toronto General Hospital, University Health Network, ON, Canada
- Toronto General Research Institute, University Health Network, ON, Canada
- University of Toronto, ON, Canada
| | - Irving Salit
- Toronto General Hospital, University Health Network, ON, Canada
- University of Toronto, ON, Canada
| | - Janet Raboud
- Toronto General Research Institute, University Health Network, ON, Canada
- University of Toronto, ON, Canada
| |
Collapse
|
17
|
Ghidei L, Simone M, Salow M, Zimmerman K, Paquin AM, Skarf LM, Kostas T, Rudolph JL. Aging, antiretrovirals, and adherence: a meta analysis of adherence among older HIV-infected individuals. Drugs Aging 2013; 30:809-19. [PMID: 23959913 PMCID: PMC3844933 DOI: 10.1007/s40266-013-0107-7] [Citation(s) in RCA: 117] [Impact Index Per Article: 10.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
INTRODUCTION Older adults are generally considered to be at greater risk for medication non-adherence due to factors such as medication complexity, side effects, cost, and cognitive decline. However, this generalization may not apply to older adults with human immunodeficiency virus (HIV). Regardless of age, suboptimal adherence to antiretroviral therapy (ART) can lead to increased viral load, immunosuppression, drug-resistant viral strains, co-morbidities, and opportunistic infections. Understanding trends of adherence to ART among older adults is critical, especially as the population of people living with HIV grows older. OBJECTIVES The purpose of this systematic review and meta-analysis is to determine if older individuals with HIV are less likely to be non-adherent to antiretroviral therapy than younger individuals with HIV. DESIGN A systematic search in PubMed, Embase, and PsycINFO was conducted to identify peer-reviewed articles evaluating adherence to ART in older adults. Two independent reviewers screened abstracts, applied inclusion criteria, and appraised study quality. The bibliographies of qualifying studies were searched. Data were abstracted from studies by two independent authors. Meta-analyses were conducted, and adherence levels were reported as the relative risk of non-adherence in older individuals compared to younger individuals. RESULTS The systematic search yielded 1,848 abstracts. Twelve studies met full inclusion criteria. The overall meta-analysis found that older age reduced risk for nonadherence by 27 % (relative risk (RR) 0.72, 95 % confidence interval (CI) 0.64–0.82). Studies assessing both short-term and long-term adherence demonstrated a significant reduction in non-adherence among older patients (RR 0.75, 95 % CI 0.64–0.87 and RR 0.65, 95 % CI 0.50–0.85, respectively). CONCLUSIONS Older adults with HIV have a reduced risk for non-adherence to ART than their younger counterparts. Future studies should seek to elucidate contributing factors of adherence among older individuals with HIV.
Collapse
Affiliation(s)
- Luwam Ghidei
- University of Texas Southwestern Medical Center, Dallas, TX
| | - Mark Simone
- Division of Aging, Brigham and Women’s Hospital, Boston, MA
- Harvard Medical School, Boston, MA
| | - Marci Salow
- Department of Pharmacy, VA Boston Healthcare System, Boston, MA
- Geriatric Research, Education, and Clinical Center, VA Boston Healthcare System, Boston, MA
| | - Kristin Zimmerman
- Department of Pharmacy, VA Boston Healthcare System, Boston, MA
- Massachusetts College of Pharmacy & Health Sciences, Boston, MA
| | - Allison M. Paquin
- Department of Pharmacy, VA Boston Healthcare System, Boston, MA
- Geriatric Research, Education, and Clinical Center, VA Boston Healthcare System, Boston, MA
| | - L. Michal Skarf
- Geriatric Research, Education, and Clinical Center, VA Boston Healthcare System, Boston, MA
- Harvard Medical School, Boston, MA
| | - Tia Kostas
- Division of Aging, Brigham and Women’s Hospital, Boston, MA
- Geriatric Research, Education, and Clinical Center, VA Boston Healthcare System, Boston, MA
- Harvard Medical School, Boston, MA
| | - James L. Rudolph
- Division of Aging, Brigham and Women’s Hospital, Boston, MA
- Geriatric Research, Education, and Clinical Center, VA Boston Healthcare System, Boston, MA
- Harvard Medical School, Boston, MA
| |
Collapse
|
18
|
Randomized clinical trial of HIV treatment adherence counseling interventions for people living with HIV and limited health literacy. J Acquir Immune Defic Syndr 2013; 63:42-50. [PMID: 23337369 DOI: 10.1097/qai.0b013e318286ce49] [Citation(s) in RCA: 48] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Limited health literacy is a known barrier to medication adherence among people living with HIV. Adherence improvement interventions are urgently needed for this vulnerable population. PURPOSE This study tested the efficacy of a pictograph-guided adherence skills-building counseling intervention for limited literacy adults living with HIV. METHODS Men and women living with HIV and receiving antiretroviral therapy (N = 446) who scored <90% correct on a test of functional health literacy were partitioned into marginal and lower literacy groups and randomly allocated to 1 of 3 adherence-counseling conditions: (1) pictograph-guided adherence counseling, (2) standard adherence counseling, or (3) general health improvement counseling. Participants were followed for 9 months postintervention with unannounced pill count adherence and blood plasma viral load as primary end points. RESULTS Preliminary analyses demonstrated the integrity of the trial and >90% of participants were retained. Generalized estimating equations showed significant interactions between counseling conditions and levels of participant health literacy across outcomes. Participants with marginal health literacy in the pictograph-guided and standard-counseling conditions demonstrated greater adherence and undetectable HIV viral loads compared with general health counseling. In contrast and contrary to hypotheses, participants with lower health literacy skills in the general health improvement counseling demonstrated greater adherence compared with the 2 adherence counseling conditions. CONCLUSIONS Patients with marginal literacy skills benefit from adherence counseling regardless of pictographic tailoring, and patients with lower literacy skills may require more intensive or provider-directed interventions.
Collapse
|
19
|
Permpalung N, Putcharoen O, Avihingsanon A, Ruxrungtham K. Treatment of HIV infection with once-daily regimens. Expert Opin Pharmacother 2012; 13:2301-17. [DOI: 10.1517/14656566.2012.729040] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
|
20
|
Kumarasamy N, Patel A, Pujari S. Antiretroviral therapy in Indian setting: when & what to start with, when & what to switch to? Indian J Med Res 2012; 134:787-800. [PMID: 22310814 PMCID: PMC3284090 DOI: 10.4103/0971-5916.92626] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023] Open
Abstract
With the rapid scale up of antiretroviral therapy, there is a dramatic decline in HIV related morbidity and mortality in both developed and developing countries. Several new safe antiretroviral, and newer class of drugs and monitoring assays are developed recently. As a result the treatment guideline for the management of HIV disease continue to change. This review focuses on evolving science on Indian policy - antiretroviral therapy initiation, which drugs to start with, when to change the initial regimen and what to change.
Collapse
Affiliation(s)
- N Kumarasamy
- YRG CARE Medical Centre, Voluntary Health Services, Chennai, India.
| | | | | |
Collapse
|
21
|
Rourke SB, Gardner S, Burchell AN, Raboud J, Rueda S, Bayoumi AM, Loutfy M, Cooper C, Smieja M, Taylor D, DiPede T, Wobeser W, Major C, Waring V, Fisher M, Cairney J, Mittmann N, Salit IE, Crouzat F, Gough K, Ralph E, Sandre R, Kilby D, Rachlis A. Cohort profile: the Ontario HIV Treatment Network Cohort Study (OCS). Int J Epidemiol 2012; 42:402-11. [PMID: 22345312 DOI: 10.1093/ije/dyr230] [Citation(s) in RCA: 54] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
The Ontario HIV Treatment Network Cohort Study (OCS) is an observational, open dynamic cohort of people who are receiving medical care for human immunodeficiency virus (HIV) infection in Ontario, Canada. Established in the mid-1990s, the OCS has its roots in AIDS activists' demands for research that would improve the quality of life of people living with HIV while respecting their privacy. It is a collaborative and community-driven study, including a Governance Committee made up of people with HIV and other stakeholders that evaluates analysis project proposals for community relevance and ethics. From 1995 to 2010, a total of 5644 participants were enrolled and 27,720 person-years of observation were accumulated; follow-up will continue until at least 2015. In the initial years of study, the focus was on clinical data from medical chart reviews. It has since evolved into a comprehensive study that collects extensive de-identified information on clinical, laboratory and psychosocial and behavioural measures based on medical chart abstractions, interviews using a standardized questionnaire and linkage with external administrative health databases in Ontario. Interested collaborators are encouraged to submit analysis project proposals as instructed on the study website (www.ohtncohortstudy.ca).
Collapse
|
22
|
Zoellner Y, Balp MM, Marco AG. The role of galenic innovation in improving treatment compliance and persistence: three case studies. CLINICOECONOMICS AND OUTCOMES RESEARCH 2011; 3:109-16. [PMID: 22046101 PMCID: PMC3202479 DOI: 10.2147/ceor.s23158] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2011] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND The purpose of this study was to explore whether newer galenic formulations with lower treatment burdens are associated with better patient compliance and persistence compared with older more burdensome modalities. METHODS Data from the IMS Disease Analyzer database were analyzed retrospectively for two pairs of analogs (alendronate sodium once daily vs once weekly and immediate-release vs extended-release methylphenidate) and one pair of drugs with similar indications but important differences in convenience and dosing instructions (desferrioxamine vs deferasirox). Compliance was calculated as the sum of prescription durations for all prescriptions for each patient over 1 year. Persistence was calculated as the time between first and last prescriptions over 2 years (1 year for deferasirox and desferrioxamine). Data from Germany and the UK were available and used for analysis. RESULTS Incremental improvements in compliance were +30% in the UK and +26% in Germany for alendronate once weekly vs once daily, +14% in the UK and +19% in Germany for extended-release vs immediate-release methylphenidate, and +15% in Germany for desferrioxamine vs deferasirox. Incremental improvements in persistence were +9 months in the UK and +8 months in Germany for alendronate once weekly vs once daily, +4 months in the UK and +3 months in Germany for extended-release vs immediate-release methylphenidate, and +2 months in Germany for deferasirox vs desferrioxamine. CONCLUSION The new formulations that we evaluated were associated with better compliance and persistence compared with older formulations. Despite the fact that some sources of bias could not be excluded, it is likely that these improvements can be attributed to the lower treatment burdens of the galenic formulations of the drugs considered. Further investigation is required to confirm these findings and to determine whether new galenic formulations can improve health outcomes in routine clinical practice.
Collapse
Affiliation(s)
- York Zoellner
- Hamburg University of Applied Sciences, Hamburg, Germany
| | | | | |
Collapse
|
23
|
Pharmacokinetics of once-daily darunavir-ritonavir and atazanavir-ritonavir over 72 hours following drug cessation. Antimicrob Agents Chemother 2011; 55:4218-23. [PMID: 21709075 DOI: 10.1128/aac.01747-10] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
The object of this study was to investigate the pharmacokinetics of darunavir-ritonavir and atazanavir-ritonavir once-daily dosing over 72 h (h) following drug intake cessation. Volunteers received darunavir-ritonavir at 800 and 100 mg, respectively, once daily for 10 days, followed by a 7-day washout period, and atazanavir-ritonavir at 300 and 100 mg, respectively, once daily for 10 days. Full pharmacokinetic profiles were assessed for each phase for the 72 h following day 10. Pharmacokinetic parameters were determined over 24 h and to the last measurable concentration by noncompartmental methods. Seventeen subjects completed the study. The geometric mean (GM) terminal elimination half-life to 72 h of darunavir was 6.48 h, which was lower than the 0- to 24-h half-life (10.70 h). The terminal elimination half-life of atazanavir was 6.74 h, which was lower than the 0- to 24-h half-life (13.72 h). All subjects but one had darunavir concentrations higher than the target of 550 ng/ml for protease-resistant HIV isolates (equivalent to 10 times the protein-binding-corrected 50% inhibitory concentration [IC(50)] for wild-type virus) at 24 h postdose, and 14 out of 17 had concentrations higher than the target at 30 h postdose (GM of 1,088 and 851 ng/ml). All subjects had atazanavir concentrations above the suggested minimum effective concentration of 150 ng/ml (equivalent to 10 times the protein-binding-corrected IC(50) for wild-type virus) at 24 and 30 h postdose (GM of 693 and 392 ng/ml). Two of 17 and 5 of 17 subjects were above target at 48 h postdose while on darunavir-ritonavir and atazanavir-ritonavir. Ritonavir half-life to 72 h was 6.84 h with darunavir and 6.07 with atazanavir. This study investigated the pharmacokinetic forgiveness of two boosted protease inhibitors. Although the rates of decline of darunavir and atazanavir slightly increased as ritonavir concentrations declined, most individuals had concentrations 6 h after the end of the ideal dosing interval of 24 h which were above the cutoff used to define therapeutic concentrations.
Collapse
|