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
. 2023 Jun 1;93(2):162-170.
doi: 10.1097/QAI.0000000000003174. Epub 2023 Feb 13.

Trajectories of Antiretroviral Therapy Adherence and Virologic Failure in Women With HIV in the United States

Abubaker Ibrahim Elbur  1 , Musie Ghebremichael  2 , Deborah Konkle-Parker  3 , Deborah L Jones  4 , Shelby Collins  5 , Adaora A Adimora  6 , Michael F Schneider  7 , Mardge H Cohen  8 , Bani Tamraz  9 , Michael Plankey  10 , Tracey Wilson  11 , Adebola Adedimeji  12 , Jessica Haberer  13 , Denise L Jacobson  14
Affiliations

Trajectories of Antiretroviral Therapy Adherence and Virologic Failure in Women With HIV in the United States

Abubaker Ibrahim Elbur et al. J Acquir Immune Defic Syndr. .

Abstract

Background: Women with HIV (WHIV) in the United States face many challenges with adherence to antiretroviral therapy (ART), and suboptimal adherence often leads to virologic failure. This study aimed to determine the association between ART adherence trajectories and the risk of virologic failure.

Methods: We included WHIV (aged 18 years or older) enrolled in the Women's Interagency HIV Study in the United States from April 2014 to September 2019 who had at least 2 consecutive measurements of HIV RNA and ≥3 measurements of self-reported adherence. Group-based trajectory modeling was used to identify adherence trajectories. Cox proportional hazard ratios were used to measure the association.

Main outcome measure: Virologic failure was defined as HIV RNA ≥200 copies/mL at 2 consecutive visits.

Results: We included 1437 WHIV (median age 49 years). Of all women, 173 (12.0%) experienced virologic failure. Four adherence trajectories were identified, namely "consistently high" (26.3%), "moderate increasing" (9.5%), "moderate decreasing" (30.6%), and "consistently low" (33.5%). Women in the consistently low adherence group consumed alcohol and experienced depression more than other groups. Compared with the "consistently high" trajectory, the risk of virologic failure was higher among women with "consistently low" [adjusted hazard ratio (aHR) 2.8; 95% confidence interval (CI): 1.6 to 4.9; P < 0.001] and "moderate decreasing" adherence trajectories (aHR 1.8; 95% CI: 1.0 to 3.2; P = 0.04), but it was similar to those with "moderate increasing" adherence trajectory (aHR 1.0; 95% CI: 0.4 to 2.5; P = 0.94).

Conclusions: Adherence to ART remains a challenge among WHIV. Multilevel behavioral interventions to address poor adherence, alcohol consumption, and depression are needed.

PubMed Disclaimer

Conflict of interest statement

The authors have no conflicts of interest to disclose.

Figures

FIGURE 1.
FIGURE 1.
Sample selection process.
FIGURE 2.
FIGURE 2.
Trajectories of ART adherence.
FIGURE 3.
FIGURE 3.
Kaplan–Meier plot of time to virologic failure by adherence trajectories.
See this image and copyright information in PMC

Update of

References

    1. Bosh KA, Hall HI, Eastham L, et al. . Estimated annual number of HIV infections─United States, 1981–2019. MMWR Morb Mortal Wkly Rep. 2021;70:801–806. - PMC - PubMed
    1. Centers for Disease Control and Prevention. Estimated HIV incidence and prevalence in the United States, 2015–2019. HIV Surveill Supplemental Rep. 2021;26. Available at: http://www.cdc.gov/hiv/library/reports/hiv-surveillance.html. Accessed April 12, 2022.
    1. Thaker HK, Snow MH. HIV viral suppression in the era of antiretroviral therapy. Postgrad Med J. 2003;79:36–42. - PMC - PubMed
    1. Kassaye SG, Wang C, Ocampo JMF, et al. . Viremia trajectories of HIV in HIV-Positive women in the United States, 1994–2017. JAMA Netw Open. 2019;3:e193822. Available at: https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2733428. Accessed August 5, 2022. - PMC - PubMed
    1. Benson C, Wang X, Dunn KJ, et al. . Antiretroviral adherence, drug resistance, and the impact of social determinants of health in HIV-1 patients in the US. AIDS Behav. 2020;24:3562–3573. - PubMed

Publication types