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Keywords:

  • adherence;
  • contraindications;
  • highly active antiretroviral therapy;
  • outcomes

Summary

Objective:  To determine whether patients who are prescribed a highly active antiretroviral therapy regimen, that minimizes medical and lifestyle contraindications, will be better able to adhere to their drug regimens and will have better clinical outcomes, than patients who do not have such a regimen.

Methods:  A retrospective chart review of patients’ prescription renewals and changes in viral load and CD4+ count and a comparison of these changes with patients’ self-identified contraindications. Contraindications were identified by a questionnaire with 35 questions relating to medical history/concurrently prescribed medication and 16 questions on lifestyle. Main outcome measures are adherence assessed by prescription renewals, change in plasma HIV-1 RNA viral loads, and change in CD4+ T-lymphocyte counts. Logistic and linear regression and student t-test were used to identify associations between outcome measurements and number of contraindications.

Results:  A total of 203 patients (72% male, 74% African-American, 7% Hispanic) completed the questionnaire. Seventy-four per cent of the patients had at least one medical/drug contraindication and 78% had at least one lifestyle contraindication. Increases in CD4 counts were reduced by an average of 13 cells/mm3 (P = 0·033) for each medical/drug contraindication and viral load decreases was significant even with one medical contraindication vs. none (P = 0·042). Patients with fewer lifestyle contraindications were more likely to have at least a 1 log drop in viral load (P = 0·036). For each increase in the number of contraindications, there was a corresponding 2% decrease in the rate of adherence (P = 0·048).

Conclusions:  The results suggest that using a patient administered questionnaire it is possible to identify contraindications in prescribed regimens that impact on adherence and on treatment effects on viral load and CD4 counts.