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| |  ASHP: Pill Burden May Contribute to Low Adherence to Antiretroviral Therapy for HIV By Bonnie Darves Special to DG News ATLANTA, GA -- December 16, 2002 -- Whether HIV-positive patients adhere to prescribed antiretroviral therapy may be influenced in part by choice of therapy and the number of pills required to maintain optimal dosing, according to a new study. Because limited data exists to support any specific antiretroviral regimen, providers treating HIV-positive patients should consider factors such as pill burden and drug intolerance in their attempts to improve therapy adherence. The new study is important because research is demonstrating that adherence is a primary determining factor of successful viral suppression-and that a rate of 95 percent is needed for optimal outcome. Researchers from the Veterans Affairs Medical Center in Miami, Florida, presented their recent findings here December 11th at the clinical meeting of the American Society of Health-System Pharmacists. The VA researchers conducted the five-year retrospective study to determine the rationale for discontinuing, switching or restarting highly active anti-retroviral therapy (HAART) in ambulatory settings. They enrolled HIV-positive patients enrolled in the medical center's immunology clinic for at least five years, starting in 1997. Patients lost to follow-up for more than six months were excluded from the study. The study includes 123 patients, 62 of whom have been evaluated to date. The patients were predominantly male (97 percent), with an average age of 53 years. Adherence was assessed based on the number of prescription refills obtained, compared with possible. Over the five-year assessment period, the overall therapy adherence rate was 71 percent. Patients switched therapy an average of 2.4 times -- on a range of 0 to 11 times -- primarily because of either drug toxicity (32.1 percent) or development of resistance, which occurred in 26.6 percent of patients. Patients on non-nucleoside reverse transcriptase inhibitor-containing regimens had higher adherence rate (77 percent) than those on protease inhibitor (PI) regimens (69.9 percent). The majority of therapy changes were due to drug toxicity (32.1 percent) and the development of resistance (26.6 percent). In the latter case, pill burden associated with protease inhibitor regimen -- which require up to 12 pills daily -- was assumed to be the chief factor in the lower adherence rates. The preliminary results also implied drug intolerance primarily dictates choice of treatment in antiretroviral therapy.
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