The Problem of Nonadherence

Initial Results with Diabetes and Hypertensive Patients

Initial Results with HIV/AIDS Drugs

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The risk of virologic failure rises with noncompliance (N=161 HIV-infected women)* 17% virologic failure with 88% or greater compliance with

drug regimen

72% virologic failure with 12% or less compliance

Predictors of nonadherence to regimen Active drug use, alcohol use

More frequent antiretroviral dosing

Improving long-term adherence in women should be a public health priority

*Howard AA, et al. AIDS. 2002;16:2175-82.

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Suboptimal adherence is a strong predictor of treatment failure

Inconvenient treatment regimens are factors associated with poor adherence

Frank I, JAIDS. 2002;31:S10–S15

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3/29/2009 4Frank I, JAIDS. 2002;31:S10–S15

OD Therapy Improves Adherence

Adherence indices rates were 60.5% in the OD cohort (n = 746) and 52% in the BID cohort (n = 246)

At 12 months, these dropped to 44.4% (OD) and 35.8% (BID)

Dezii DM, et al. South Med J. 2002;95(1):68-71.

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1. Methods such as drug regimen simplification should be aggressively sought to improve adherence.

2. Improved adherence rates may be achieved with a once-daily regimen despite a higher pill burden.

3. Once-daily pharmacotherapy results in higher adherence and persistence with therapy compared with a twice-daily regimen.

Dezii DM, et al. South Med J. 2002;95(1):68-71.

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Overall compliance was 98.9% with OD therapy, and 97.5% with BID therapy (n = 133)

2.6% missed doses in the OD group, and 3.3% missed doses in the BID group

Blood pressure normalized (<140 mm Hg systolic and <90 mm Hg diastolic) in 41% of the OD patients and 27% of the BID patients

Andrejak M, et al. Am J Hypertens. 2000;13:184–190.

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Patients (n = 69) with viral loads of <50 HIV-1 RNA copies/mL were switched after 2 years of therapy on BID saquinavir soft-gelatin capsules (SQV-SGC) (1400 mg) plus zidovudine/ lamivudine or didanosine/stavudine to OD SQV-SGC/RTV (1600/100 mg) with continuing nucleoside reverse transcriptase inhibitors (NRTIs).

Cardiello PG, et al. JAIDS. 2002;29:464–470.

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93% (n = 64) had plasma viral loads of <50 copies/mL 24 weeks after switching regimens

5 patients had plasma viral loads of <300 copies/mL

Median CD4 cell count increased from 534/mL to 695/mL in the 24 weeks (p < .001) since switching to OD treatment

Cardiello PG, et al. JAIDS. 2002;29:464–470.

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The data suggests that the combination of SQV-SGC/RTV (1600/100 mg) once daily plus two NRTIs may be a realistic option to

simplify PI-containing therapy and

improve compliance in a select group of HIV-1–infected patients with plasma viral loads of <50 copies/mL.

Cardiello PG, et al. JAIDS. 2002;29:464–470.

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Adherence remains one of the greatest challenges for patients receiving antiretroviral treatment

Increased simplification of treatment regimens should assist in improving the long-term adherence to therapy and maintaining treatment efficacy

Frank I, JAIDS. 2002;31:S10–S15.

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In the future, once-daily regimens will become the standard of care for HIV infection

Several currently available antiretroviral drugs can be used once daily, or

have the pharmacokinetic potential for once-daily dosing, and

others are in development

Frank I, JAIDS. 2002;31:S10–S15.

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1. Gifford AL, Bormann JE, Shively MJ, Wright, BC, Richman DD, Bozzette SA: Predictors of self-reported adherence and plasma HIV concentrations in patients on multidrug antiretroviral regimens. JAIDS. 2000;23:386–395.

2. Howard AA, Arnsten JH, Yungtai L,Vlahov D, et al; for HER Study Group. A prospective study of adherence and viral load in a large multi-center cohort of HIV-infected women. AIDS. 2002;16:2175–2182.

3. Paterson DL, Swindells S, Mohr J, et al. Adherence to protease inhibitor therapy and outcomes

in patients with HIV infection. Ann Intern Med. 2000;133:21–30.

4. Mannerheimer S, Friedland G, Matts J, et al. Self-reported antiretroviral adherence correlates with HIV viral load and declines over time [abstract TuOrB421]. Abstract presented at the XIII International AIDS Conference; Durban, South Africa; July 9–14, 2000; Abstracts-On-Disk, XIII International AIDS Conference [CD-ROM] published by Merck Sharp & Dohme.

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5. Dezii CM, Kawabata H, Tran M: Effects of once-daily and twice-daily dosing on adherence with prescribed glipizide oral therapy for type 2 diabetes. South Med J. 2002;95(1):68-71.

6. Andrejak M. Electronic Pill-Boxes in the Evaluation of Antihypertensive Treatment Compliance: Comparison of Once Daily Versus Twice Daily Regimen. Am J Hypertens. 2000;13:184–190.

7. Cardiello PG, et al. Simplifying protease inhibitor therapy with once-daily dosing of saquinavir soft-gelatin capsules/ritonavir (1600/100 mg): HIVNAT 001.3 study. JAIDS. 2002;29:464–470.

8. Frank I. Once-daily HAART: toward a new treatment paradigm. JAIDS. 2002;31:S10–S15.

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