| Adherence to protease inhibitor therapy and outcomes in patients with HIV infection. | |
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MedLine Citation:
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PMID: 10877736 Owner: NLM Status: MEDLINE |
Abstract/OtherAbstract:
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BACKGROUND: Combination antiretroviral therapy with protease inhibitors has transformed HIV infection from a terminal condition into one that is manageable. However, the complexity of regimens makes adherence to therapy difficult. OBJECTIVE: To assess the effects of different levels of adherence to therapy on virologic, immunologic, and clinical outcome; to determine modifiable conditions associated with suboptimal adherence; and to determine how well clinicians predict patient adherence. DESIGN: Prospective, observational study. SETTING: HIV clinics in a Veterans Affairs medical center and a university medical center. PATIENTS: 99 HIV-infected patients who were prescribed a protease inhibitor and who neither used a medication organizer nor received their medications in an observed setting (such as a jail or nursing home). MEASUREMENTS: Adherence was measured by using a microelectronic monitoring system. The adherence rate was calculated as the number of doses taken divided by the number prescribed. Patients were followed for a median of 6 months (range, 3 to 15 months). RESULTS: During the study period, 45,397 doses of protease inhibitor were monitored in 81 evaluable patients. Adherence was significantly associated with successful virologic outcome (P < 0.001) and increase in CD4 lymphocyte count (P = 0.006). Virologic failure was documented in 22% of patients with adherence of 95% or greater, 61% of those with 80% to 94.9% adherence, and 80% of those with less than 80% adherence. Patients with adherence of 95% or greater had fewer days in the hospital (2.6 days per 1000 days of follow-up) than those with less than 95% adherence (12.9 days per 1000 days of follow-up; P = 0.001). No opportunistic infections or deaths occurred in patients with 95% or greater adherence. Active psychiatric illness was an independent risk factor for adherence less than 95% (P = 0.04). Physicians predicted adherence incorrectly for 41% of patients, and clinic nurses predicted it incorrectly for 30% of patients. CONCLUSIONS: Adherence to protease inhibitor therapy of 95% or greater optimized virologic outcome for patients with HIV infection. Diagnosis and treatment of psychiatric illness should be further investigated as a means to improve adherence to therapy. |
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Authors:
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D L Paterson; S Swindells; J Mohr; M Brester; E N Vergis; C Squier; M M Wagener; N Singh |
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Publication Detail:
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Type: Journal Article |
Journal Detail:
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Title: Annals of internal medicine Volume: 133 ISSN: 0003-4819 ISO Abbreviation: Ann. Intern. Med. Publication Date: 2000 Jul |
Date Detail:
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Created Date: 2000-06-29 Completed Date: 2000-06-29 Revised Date: 2007-11-15 |
Medline Journal Info:
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Nlm Unique ID: 0372351 Medline TA: Ann Intern Med Country: UNITED STATES |
Other Details:
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Languages: eng Pagination: 21-30 Citation Subset: AIM; IM; X |
Affiliation:
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Veterans Affairs Medical Center, Pittsburgh, Pennsylvania 15240, USA. |
Export Citation:
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APA/MLA Format Download EndNote Download BibTex |
| MeSH Terms | |
Descriptor/Qualifier:
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Adult Anti-HIV Agents / therapeutic use* CD4 Lymphocyte Count Female Follow-Up Studies HIV Infections / complications, drug therapy*, immunology, virology Hospitalization Humans Male Mental Disorders / complications Middle Aged Patient Compliance* Prospective Studies Protease Inhibitors / therapeutic use* Questionnaires Risk Factors Statistics as Topic Treatment Outcome Viral Load |
| Chemical | |
Reg. No./Substance:
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0/Anti-HIV Agents; 0/Protease Inhibitors |
| Comments/Corrections | |
Comment In:
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Ann Intern Med. 2001 Apr 3;134(7):625
[PMID:
11281748
]
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Erratum In:
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Ann Intern Med 2002 Feb 5;136(3):253 |
From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine
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