Identifying risk of viral failure in treated HIV-infected patients using different measures of adherence: The Antiretroviral Therapy Cohort Collaboration. Journal of Clinical Medicine
Ingle et al. on behalf of the Antiretroviral Therapy Cohort Collaboration aimed to assess the utility of different adherence measures for identification of patients at risk of viral failure (VF).
Eight cohorts contributed data from pharmacy refills or self-report questionnaires collected between 1996 and 2013 (N = 11689). For pharmacy data (N = 7156), associations of percentage adherence during the 1st year of ART with VF (>500 copies/mL) at 1 year were examined. For self-report data (N = 4533), 28 day adherence with VF based on closest viral load measure within 6 months after questionnaire date was examined. Since adherence differed markedly by measurement type, the authors defined different cut-off points for pharmacy (lower <45%, medium 45–99%, higher 100%) and self-report (lower ≤95%, medium 96–99%, higher 100%) data.
Adjusted odds ratios (ORs) for VF in lower and medium, compared to higher adherence groups, were 23.04 (95% CI: 18.44–28.78) and 3.84 (3.36–4.39) for pharmacy data. For self-report data, they were 3.19 (2.31–4.40) and 1.08 (0.80–1.46). Both types of measure were strongly associated with VF.
In conclusion, the study results suggest that both self-report and pharmacy refill adherence data can be used to predict viral failure and show evidence that increasing adherence decreases the risk of viral failure. In the current study, pharmacy measures were much more strongly associated with viral failure than self-reported measures, although this may be due, in part, to the longer time-frame used in the pharmacy data and the higher % with viral failure in the pharmacy cohorts. To make full use of adherence data, there needs to be an awareness of cohort-specific factors affecting adherence. In addition, harmonization of pharmacy refill data management should be attempted in order to ensure that all cohorts are using the same tools.
Additional comment Dr. Dominique Braun and Prof. Huldrych Günthard
With this 65th press release in 2018, we say good-bye to you and wish you and your families a merry Christmas and a happy New Year. We hope that you will read us again in 2019 and that we can continue to provide you interesting results from the SHCS research community.