1. Which method of adherence measurement is most suitable for daily use to predict virological failure among immigrant and non-immigrant HIV-1 infected patients?
- Author
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Nellen JF, Nieuwkerk PT, Burger DM, Wibaut M, Gras LA, and Prins JM
- Subjects
- Adult, Africa South of the Sahara ethnology, Anti-HIV Agents blood, Female, HIV Infections ethnology, HIV Infections virology, Humans, Interviews as Topic, Male, Medication Adherence ethnology, Middle Aged, Netherlands epidemiology, Netherlands Antilles ethnology, RNA, Viral blood, Suriname ethnology, Treatment Failure, Anti-HIV Agents therapeutic use, Antiretroviral Therapy, Highly Active, Emigrants and Immigrants statistics & numerical data, HIV Infections drug therapy, HIV-1, Medication Adherence statistics & numerical data
- Abstract
In industrialized countries, virological failure occurs more often among HIV-infected immigrant patients. Non-adherence is the most credible explanation. We compared adherence of immigrant patients with that of non-immigrant patients in the Netherlands, and investigated which method of adherence measurement is most suitable for daily use to predict virological treatment failure: testing knowledge of the current regimen, a quantitative adherence interview, pharmacy prescription refill ratio (dispensed medication divided by prescribed medication, DM/PM), and plasma drug levels. Included were 61 immigrants and 81 non-immigrants. Virological failure did occur more often in immigrants than in non-immigrants (19.7% (12/61) versus 8.6% (7/81), p=0.056), especially among previously naive patients (19.6% (11/56) versus 0% (0/54), p<0.01). There were no differences between both groups on any of the four adherence measures. Virological failure was associated with reporting stopping medication when not feeling well (OR=12, 95%CI=1.9-77.7, p=0.02), and, among naive patients, also with a DM/PM < 0.85 (Odds Ratio=5.1, 95%Confidence Interval=1.2-22.3, p=0.03). Although our study confirmed a much higher virological failure rate among immigrants, we were unable to identify clear differences in adherence between immigrants and non-immigrant patient, although virological failure was associated with stopping medication when not feeling well and a low DM/PM. Unstructured treatment interruptions are a likely explanation of the findings. Interventions should be aimed at preventing patients to stop medication. A DM/PM below 0.85 can be indicative for patients who did stop medication and are at risk for virological failure.
- Published
- 2009
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