Limited patient adherence to highly active antiretroviral therapy for HIV-1 infection in an observational cohort study

Background: Adherence to highly active antiretroviral therapy (HAART) for h uman immunodeficiency syndrome type 1 (HIV-1) infection is essential to sus tain viral suppression and prevent drug resistance. We investigated adheren ce to HAART among patients in a clinical cohort study. Methods: Patients receiving HAART had their plasma concentrations of protea se inhibitors or nevirapine measured and completed a questionnaire on adher ence, We determined the percentage of patients who reported taking all anti retroviral medication on time and according to dietary instructions in the past week. Drug exposure was compared between patients reporting deviation from their regimen and fully adherent patients. Among patients who received HAART for at least 24 weeks, we assessed the association between adherence and virologic outcome. Results: A total of 224 of 261 eligible patients completed a questionnaire. Forty-seven percent reported taking all antiretroviral medication on time and according to dietary instructions. Patients who reported deviation from their regimen showed lower drug exposure compared with fully adherent pati ents (median concentration ratio, 0.81 vs 1.07; P=.001). Among those receiv ing HAART for at least 24 weeks, patients reporting deviation from their re gimen were less likely to have plasma HIV-1 RNA levels below 500 copies/mL (adjusted odds ratio, 4.0; 95% confidence interval, 1.4-11.6) compared with fully adherent patients. Conclusions: Only half of the patients took all antiretroviral medication i n accordance with time and dietary instructions in the preceding week. Devi ation from the antiretroviral regimen was associated with decreased drug ex posure and a decreased likelihood of having suppressed plasma HIV-1 RNA loa ds. Patient adherence should remain a prime concern in the management of HI V-1 infection.