Association of incomplete adherence to antiretroviral therapy with cardiovascular events and mortality in virologically suppressed persons with HIV: The Swiss HIV Cohort Study. Open Forum Infectious Diseases
Castillo-Mancilla et al. aimed to assess the clinical implications of incomplete antiretroviral therapy (ART) adherence on the occurrence of cardiovascular events (CVD) and non-CVD-related death.
Persons with HIV (PWH) enrolled in the Swiss HIV Cohort Study without a history of CVD who initiated ART between 2003 and 2018 and had viral suppression (<50 copies/mL) for ≥6 months were evaluated for the association between incomplete self-reported ART adherence and (1) any CVD event (myocardial infarction, revascularization, cerebral hemorrhage, stroke, and/or death due to CVD event) or (2) non-CVD-related death. Incomplete ART adherence was defined as 1 or ≥2 self-reported missed doses in the last month.
A total of 6’971 PWH (74% male) were included in the analysis (median age [interquartile range {IQR}], 39 [32–47] years). The median (IQR) follow-up was 8 (4–11) years, with 14 (8–23) adherence questionnaires collected per participant. In total, 205 (3%) participants experienced a CVD event, and 186 (3%) died a non-CVD-related death. In an adjusted competing risk model where missing data were imputed, missing ≥1 ART dose showed an increased, but not statistically significant, risk for CVD events (hazard ratio [HR], 1.23; 95% CI, 0.85–1.79; P = .28). Non-CVD-related mortality showed a statistically significantly increased risk with missing ≥1 ART dose (HR, 1.44; 95% CI, 1.00–2.07; P = .05) and missing ≥2 ART doses (HR, 2.21; 95% CI, 1.37–3.57; P = .001).
In conclusion, the study demonstrated that incomplete (i.e., <100%) ART adherence is associated with an increased risk for non-CVD-related mortality in PWH who are virologically suppressed to <50 copies/mL. These findings suggest the potential critical role that ART adherence could have in improving clinical outcomes and open the door for further research on the role that increasing adherence – beyond suppression – could have in preventing morbidity/mortality in PWH who are considered optimally treated. Future studies to confirm this association and to understand its clinical implications are needed.