Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2009 Apr 15;50(5):529-36.
doi: 10.1097/QAI.0b013e31819675e9.

The combined effect of modern highly active antiretroviral therapy regimens and adherence on mortality over time

Viviane D Lima  1 , Richard Harrigan, David R Bangsberg, Robert S Hogg, Robert Gross, Benita Yip, Julio S G Montaner
Affiliations

The combined effect of modern highly active antiretroviral therapy regimens and adherence on mortality over time

Viviane D Lima et al. J Acquir Immune Defic Syndr. .

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.

PubMed Disclaimer

Conflict of interest statement

V.D.L. and B.Y. declare no conflict.

Figures

FIGURE 1
FIGURE 1
Hazard ratio for mortality of 903 patients with HIV, stratified by adherence initial regimen. Vertical bars, 95% CI.
See this image and copyright information in PMC

References

    1. Hogg RS, Heath KV, Yip B, et al. Improved survival among HIV-infected individuals following initiation of antiretroviral therapy. JAMA. 1998;279:450–454. - PubMed
    1. Moore RD, Chaisson RE. Natural history of HIV infection in the era of combination antiretroviral therapy. AIDS. 1999;13:1933–1942. - PubMed
    1. Palella FJ, Jr, Delaney KM, Moorman AC, et al. Declining morbidity and mortality among patients with advanced human immunodeficiency virus infection. N Engl J Med. 1998;338:853–860. - PubMed
    1. Wood E, Hogg RS, Harrigan PR, et al. When to initiate antiretroviral therapy in HIV-1-infected adults: a review for clinicians and patients. Lancet Infect Dis. 2005;5:407–414. - PubMed
    1. Knobel H, Carmona A, Grau S, et al. Adherence and effectiveness of highly active antiretroviral therapy. Arch Intern Med. 1998;158:1953. - PubMed

Publication types

Substances