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The Problem of Nonadherence
Initial Results with Diabetes and Hypertensive Patients
Initial Results with HIV/AIDS Drugs
3/29/2009 1
The risk of virologic failure rises with noncompliance (N=161 HIV-infected women)* 17% virologic failure with 88% or greater compliance with
drug regimen
72% virologic failure with 12% or less compliance
Predictors of nonadherence to regimen Active drug use, alcohol use
More frequent antiretroviral dosing
Improving long-term adherence in women should be a public health priority
*Howard AA, et al. AIDS. 2002;16:2175-82.
3/29/2009 2
Suboptimal adherence is a strong predictor of treatment failure
Inconvenient treatment regimens are factors associated with poor adherence
Frank I, JAIDS. 2002;31:S10–S15
3/29/2009 3
3/29/2009 4Frank I, JAIDS. 2002;31:S10–S15
OD Therapy Improves Adherence
Adherence indices rates were 60.5% in the OD cohort (n = 746) and 52% in the BID cohort (n = 246)
At 12 months, these dropped to 44.4% (OD) and 35.8% (BID)
Dezii DM, et al. South Med J. 2002;95(1):68-71.
3/29/2009 5
1. Methods such as drug regimen simplification should be aggressively sought to improve adherence.
2. Improved adherence rates may be achieved with a once-daily regimen despite a higher pill burden.
3. Once-daily pharmacotherapy results in higher adherence and persistence with therapy compared with a twice-daily regimen.
Dezii DM, et al. South Med J. 2002;95(1):68-71.
3/29/2009 6
Overall compliance was 98.9% with OD therapy, and 97.5% with BID therapy (n = 133)
2.6% missed doses in the OD group, and 3.3% missed doses in the BID group
Blood pressure normalized (<140 mm Hg systolic and <90 mm Hg diastolic) in 41% of the OD patients and 27% of the BID patients
Andrejak M, et al. Am J Hypertens. 2000;13:184–190.
3/29/2009 7
Patients (n = 69) with viral loads of <50 HIV-1 RNA copies/mL were switched after 2 years of therapy on BID saquinavir soft-gelatin capsules (SQV-SGC) (1400 mg) plus zidovudine/ lamivudine or didanosine/stavudine to OD SQV-SGC/RTV (1600/100 mg) with continuing nucleoside reverse transcriptase inhibitors (NRTIs).
Cardiello PG, et al. JAIDS. 2002;29:464–470.
3/29/2009 8
93% (n = 64) had plasma viral loads of <50 copies/mL 24 weeks after switching regimens
5 patients had plasma viral loads of <300 copies/mL
Median CD4 cell count increased from 534/mL to 695/mL in the 24 weeks (p < .001) since switching to OD treatment
Cardiello PG, et al. JAIDS. 2002;29:464–470.
3/29/2009 9
The data suggests that the combination of SQV-SGC/RTV (1600/100 mg) once daily plus two NRTIs may be a realistic option to
simplify PI-containing therapy and
improve compliance in a select group of HIV-1–infected patients with plasma viral loads of <50 copies/mL.
Cardiello PG, et al. JAIDS. 2002;29:464–470.
3/29/2009 10
Adherence remains one of the greatest challenges for patients receiving antiretroviral treatment
Increased simplification of treatment regimens should assist in improving the long-term adherence to therapy and maintaining treatment efficacy
Frank I, JAIDS. 2002;31:S10–S15.
3/29/2009 11
In the future, once-daily regimens will become the standard of care for HIV infection
Several currently available antiretroviral drugs can be used once daily, or
have the pharmacokinetic potential for once-daily dosing, and
others are in development
Frank I, JAIDS. 2002;31:S10–S15.
3/29/2009 12
1. Gifford AL, Bormann JE, Shively MJ, Wright, BC, Richman DD, Bozzette SA: Predictors of self-reported adherence and plasma HIV concentrations in patients on multidrug antiretroviral regimens. JAIDS. 2000;23:386–395.
2. Howard AA, Arnsten JH, Yungtai L,Vlahov D, et al; for HER Study Group. A prospective study of adherence and viral load in a large multi-center cohort of HIV-infected women. AIDS. 2002;16:2175–2182.
3. Paterson DL, Swindells S, Mohr J, et al. Adherence to protease inhibitor therapy and outcomes
in patients with HIV infection. Ann Intern Med. 2000;133:21–30.
4. Mannerheimer S, Friedland G, Matts J, et al. Self-reported antiretroviral adherence correlates with HIV viral load and declines over time [abstract TuOrB421]. Abstract presented at the XIII International AIDS Conference; Durban, South Africa; July 9–14, 2000; Abstracts-On-Disk, XIII International AIDS Conference [CD-ROM] published by Merck Sharp & Dohme.
3/29/2009 13
5. Dezii CM, Kawabata H, Tran M: Effects of once-daily and twice-daily dosing on adherence with prescribed glipizide oral therapy for type 2 diabetes. South Med J. 2002;95(1):68-71.
6. Andrejak M. Electronic Pill-Boxes in the Evaluation of Antihypertensive Treatment Compliance: Comparison of Once Daily Versus Twice Daily Regimen. Am J Hypertens. 2000;13:184–190.
7. Cardiello PG, et al. Simplifying protease inhibitor therapy with once-daily dosing of saquinavir soft-gelatin capsules/ritonavir (1600/100 mg): HIVNAT 001.3 study. JAIDS. 2002;29:464–470.
8. Frank I. Once-daily HAART: toward a new treatment paradigm. JAIDS. 2002;31:S10–S15.
3/29/2009 14