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Comparative Study
. 2001 Oct 15;33(8):1417-23.
doi: 10.1086/323201. Epub 2001 Sep 5.

Antiretroviral therapy adherence and viral suppression in HIV-infected drug users: comparison of self-report and electronic monitoring

J H Arnsten  1 , P A Demas, H Farzadegan, R W Grant, M N Gourevitch, C J Chang, D Buono, H Eckholdt, A A Howard, E E Schoenbaum
Affiliations
Comparative Study

Antiretroviral therapy adherence and viral suppression in HIV-infected drug users: comparison of self-report and electronic monitoring

J H Arnsten et al. Clin Infect Dis. .

Abstract

To compare electronically monitored (MEMS) with self-reported adherence in drug users, including the impact of adherence on HIV load, we conducted a 6-month observational study of 67 antiretroviral-experienced current and former drug users. Adherence (percentage of doses taken as prescribed) was calculated for both the day and the week preceding each of 6 research visits. Mean self-reported 1-day adherence was 79% (median, 86%), and mean self-reported 1-week adherence was 78% (median, 85%). Mean MEMS 1-day adherence was 57% (median, 52%), and mean MEMS 1-week adherence was 53% (median, 49%). One-day and 1-week estimates were highly correlated (r>.8 for both measures). Both self-reported and MEMS adherence were correlated with concurrent HIV load (r=.43-.60), but the likelihood of achieving virologic suppression was greater if MEMS adherence was high than if self-reported adherence was high. We conclude that self-reported adherence is higher than MEMS adherence, but a strong relationship exists between both measures and virus load. However, electronic monitoring is more sensitive than self-report for the detection of nonadherence and should be used in adherence intervention studies.

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Figures

Figure 1
Figure 1
Subjects were categorized by quartile of electronic monitoring (MEMS) adherence: (1) <20%, (2) 20%–49%, (3) 50%–89%, and (4) ≥90%. Among the 22 subjects with a virus load of <500 copies/mL, the number and percentage in each quartile by both MEMS and self-reported adherence are indicated.
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