Regimen‐dependent variations in adherence to therapy and virological suppression in patients initiating protease inhibitor‐based highly active antiretroviral therapy
HIV medicine, 2006•Wiley Online Library
Objective To examine differences among four protease inhibitor (PI)‐based drug regimens
in adherence to therapy and rate of achievement of virological suppression in a cohort of
antiretroviral‐naive patients initiating highly active antiretroviral therapy (HAART). Methods
Participants were antiretroviral‐naive and were first dispensed combination therapy
containing two nucleosides and a ritonavir (RTV)‐boosted PI, or unboosted nelfinavir,
between 1 January 2000 and 30 September 2003. Logistic regression analysis was used to …
in adherence to therapy and rate of achievement of virological suppression in a cohort of
antiretroviral‐naive patients initiating highly active antiretroviral therapy (HAART). Methods
Participants were antiretroviral‐naive and were first dispensed combination therapy
containing two nucleosides and a ritonavir (RTV)‐boosted PI, or unboosted nelfinavir,
between 1 January 2000 and 30 September 2003. Logistic regression analysis was used to …
Objective
To examine differences among four protease inhibitor (PI)‐based drug regimens in adherence to therapy and rate of achievement of virological suppression in a cohort of antiretroviral‐naive patients initiating highly active antiretroviral therapy (HAART).
Methods
Participants were antiretroviral‐naive and were first dispensed combination therapy containing two nucleosides and a ritonavir (RTV)‐boosted PI, or unboosted nelfinavir, between 1 January 2000 and 30 September 2003. Logistic regression analysis was used to examine associations between the prescribed PI and other baseline factors associated with being >90% adherent to therapy and then to determine the associations of prescribed drug regimen, adherence to therapy and baseline variables with the odds of achieving two consecutive viral loads of <500 HIV‐1 RNA copies/mL.
Results
A total of 385 subjects were available for analysis. Lopinavir (LPV)/RTV was prescribed for 168 patients (42% of total); 86 (22%) received indinavir (IDV)/RTV; 91 (24%) received nelfinavir (NFV) and 40 (10%) received saquinavir (SQV)/RTV. SQV/RTV‐based HAART was associated with reduced adherence to therapy [odds ratio (OR)=0.40; 95% confidence interval (CI) 0.19–0.83]. In multivariate models, IDV/RTV (OR=0.45; 95% CI 0.22–0.92), SQV/RTV (OR=0.18; 95% CI 0.07–0.43) and NFV were associated with reduced odds of achieving virological suppression within 1 year in comparison to LPV/RTV‐based therapy. For patients receiving NFV, adjusting for adherence (OR=0.73; 95% CI 0.36–1.47) rendered this association nonsignificant.
Conclusion
Patients prescribed IDV/RTV, NFV or SQV/RTV were less likely to achieve virological suppression on their first regimen compared with patients prescribed LPV/RTV. Reduced adherence to these therapies only partly explained these observed differences.
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