AEGiS-13IAC: Non-adherence to triple combination therapy is predictive of AIDS progression and death in HIV-positive men and women.

13th International AIDS Conference

Durban, South Africa - July 9-July 14, 2000

Non-adherence to triple combination therapy is predictive of AIDS progression and death in HIV-positive men and women.

Int Conf AIDS 2000 Jul 9-14; 13:(abstract no. TuOrB419)

Hogg R, Yip B, Chan K, O'Shaughnessy M, Montaner J
R. Hogg, BC Centre for Excellence in HIV/AIDS, 608-1081 Burrard St, Vancouver BC, Canada, Tel.: +1 604 631 5516, Fax: +1 604 631 5464, E-mail: ewood@hivnet.ubc.ca

OBJECTIVE: To characterize the response to antiretroviral (ARV) therapy among participants enrolled in a population-based anti-HIV drug treatment program in British Columbia (BC).

METHODS: In BC antiretroviral therapies are distributed free of charge according to specific therapeutic guidelines. Study subjects were ARV naive, started triple therapy with 2 NRTIs and a PI or a NNRTI between 08/96-12/98, with baseline plasma viral load. The primary outcome and secondary outcome measures in our analysis were death and a primary AIDS diagnosis respectively. Rates of progression from the initiation of ARV therapy to death or to diagnosis of primary AIDS were determined using K-M methods. Cox-proportion hazard models were used to estimate the hazard of death and AIDS-free survival. Adherence was estimated by dividing the number of months of documented prescriptions dispensed by the number of months of follow-up in the first year of ARV therapy. Non-Adherence was measured per 10% decline in drug adherence. All p-values are two-sided.

RESULTS: A total of 950 subjects (815 men/135 women) were studied. The median time on antiretroviral therapy was 13 months (IQR 7-21 months. A total 64 deaths and 11 primary AIDS diagnoses were prospectively observed in this study. The cumulative mortality was 3.6% (+ 0.6) at 12 months. In a multivariate model, death was independently associated with being non-adherent to therapy (ARR = 1.16; 95% CI: 1.06 - 1.26; p > 0.001) and having a lower CD4 cell count (ARR = 1.35; 95% CI: 1.13- 1.61; p = 0.001) at baseline. The results were unchanged when AIDS free survival was the primary outcome.

CONCLUSION: This study demonstrates that non-adherent participants are less-likely respond to ARV therapy and more likely to progress than adherent persons. Clearly, these results demonstrate the importance of treatment adherence independent of baseline clinical markers and physician experience

Keywords: AEGIS, Acquired Immunodeficiency Syndrome, HIV Infections, CD4 Lymphocyte Count, HIV Seropositivity, Anti-HIV Agents, Viral Load, Antiretroviral Therapy, Highly Active, Proportional Hazards Models, Death, Drug Therapy, Combination, British Columbia, Human, Female, Male, therapy, drug therapy
000709
TuOrB419