Antiretroviral nonadherence and condomless sex in the HIV Outpatient Study, USA, 2007-2014

Abstract

Effective antiretroviral therapy (ART) reduces plasma HIV RNA viral load (VL) to undetectable levels and its effectiveness depends on consistent adherence. Consistent adherence and use of safe sex practices may substantially decrease the risk of HIV transmission. We sought to explore the potential association between self-reported nonadherence to ART and engaging in unsafe sexual practices capable of transmitting HIV. Using clinical and audio computer-assisted self-interview data from the prospective HIV Outpatient Study from 2007 to 2014, we assessed the frequency of self-reported ART nonadherence during the three days prior to the survey among HIV-infected persons in care and factors associated with self-reported ART nonadherence. Of 1729 patients included in this analysis (median age = 48 years, 74.3% men who have sex with men), 17% were nonadherent, 15% had a detectable VL, and 42% reported condomless anal or vaginal sex in the past six months. In multivariable analysis, self-reported nonadherence was independently associated with younger age (adjusted odds ratio [aOR] 0.8 per additional ten years, [95% CI] 0.7-1.0), non-Hispanic black race/ethnicity (aOR 1.9; 95% CI 1.4-2.6 versus white), public health insurance (aOR 1.6, 95% CI 1.2-2.3 compared with private), survey date in 2011-2014 versus 2007-2010 (aOR 0.7, 95% CI 0.5-0.9), CD4 cell count ≥ 500 versus < 200 cells/mm³ (aOR 0.3, 95% CI 0.2-0.5), greater number of ART regimen doses (aOR 1.6, 95% CI 1.3-2.2), and binge drinking (aOR 1.4, 95% CI, 1.1-1.9). In this analysis, self-reported nonadherence was not associated with engaging in condomless sex.

Keywords: HIV; adherence; antiretroviral therapy; condomless sex; risk behavior.

Figure 1.

Characteristics of MSM and heterosexual patients completing an ACASI, HIV Outpatient Study, USA, 2007–2014 (N = 1729). ACASI: audio computer-assisted self-interview; MSM: gay, bisexual and other men who have sex with men. Condomless sex was defined as self-report of anal or vaginal sex without a condom in the six months before interview. Discordance was defined as having condomless sex with partners of unknown HIV status or who were known to be HIV-negative and was only defined for those who have reported having condomless sex. Viral load was the closest viral load to the date of ACASI within six months prior and one month after the survey. Nonadherence was defined as missing at least one HIV medication dose during the three days prior to ACASI. P-values for differences in categories were obtained using a Chi square test; N shows number with the characteristic (numerator).