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2011 HSR&D National Meeting Abstract

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2011 National Meeting

3052 — Fewer Than a Quarter of HIV-Positive Veterans Adhere to Medications at Recommended Levels

LaFleur J (Salt Lake City VA), Nelson RE (Salt Lake City VA), Hayden C (Salt Lake City VA), Reimer L (University of Utah), Kone K (Salt Lake City VA), Nebeker J (Salt Lake City VA)

Best practice guidelines urge use of 3-4 drug regimens for treatment of human immunodeficiency virus (HIV) and recommend near-perfect levels of patient adherence (95%) to avoid treatment failure and development of drug-resistant infection. Veteran adherence to multi-drug regimens in HIV is not well-quantified; we report on veterans’ adherence to antiretroviral multi-drug therapy.

Incident cases of HIV seropositive, antiretroviral-naïve patients initiating therapy from 1998-2006 were identified using data from the Veterans Health Administration (VHA) Clinical Case Registry (CCR). We defined antiretroviral-naïve as not having prior treatment in the VHA. Because patients often come to the VHA after receiving treatment outside the system, we also excluded patients if: (1) the first regimen was a ‘salvage’ regimen (composed of both a protease inhibitor [PI] and a non-nucleoside reverse transcriptase inhibitor [nNRTI] or composed of >= 5 agents), (2) HIV prognostic indices were not measured before the first ART prescription, and (3) all HIV-RNA levels before the first prescription were low enough to suggest prior treatment. The proportion of days covered (PDC) by 3 or more agents was calculated from pharmacy data over quarterly intervals between each patient’s first and last fill.

A total of 7,060 veterans met all inclusion criteria and were considered new starts. The mean age of the cohort was 56.3 (SD 9.4) and 97.6% were male. Average duration of therapy was 4.8 years (SD 2.6). Mean PDC was 20.9% (95% CI 20.2-21.7%) in quarter 1 among 7,060 veterans, which increased to 27.0% (95% CI 26.1-27.9%) in quarter 2 among 6,920 veterans. Mean PDC reached a maximum of 43.3% (95% CI 41.6-45.0) in quarter 26 among 2,451 veterans. The proportions of patients who adhered to at least 95% and 80% of 3 or more drugs ranged from 6.2% and 9.8% in quarter 1 to 23.0% and 32.2% in quarter 30 among 1,819 patients.

Only a very small proportion of veterans with HIV had adherence to therapy in the “optimal” range.

To minimize risk of treatment failure and HIV drug resistance, interventions are needed to identify patients likely to be poorly adherent and to optimize adherence.

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