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Nonadherence Increases the Risk of Hospitalization Among HIV-Infected Antiretroviral Naïve Patients Started on HAART

B.C. Centre for Excellence in HIV/AIDS, Vancouver, British Columbia, Canada, Department of Interdisciplinary Studies, University of British Columbia, Vancouver, British Columbia, Canada

Melanie L. A. Rusch, PhD

Division of International Health & Cross-Cultural Medicine, University of California, San Diego, California, mrusch{at}ucsd.edu

Benita Yip, BSc

B.C. Centre for Excellence in HIV/AIDS, Vancouver, British Columbia, Canada

Evan Wood, PhD

B.C. Centre for Excellence in HIV/AIDS, Vancouver, British Columbia, Canada, Department of Medicine, University of British Columbia, Vancouver, British Columbia, Canada

Kate Shannon, PhD

B.C. Centre for Excellence in HIV/AIDS, Vancouver, British Columbia, Canada, Department of Health Care and Epidemiology, University of British Columbia, Vancouver, British Columbia, Canada

Adrian R. Levy, PhD

Department of Health Care and Epidemiology, University of British Columbia, Vancouver, British Columbia, Canada

Julio S. G. Montaner, MD

B.C. Centre for Excellence in HIV/AIDS, Vancouver, British Columbia, Canada, Department of Medicine, University of British Columbia, Vancouver, British Columbia, Canada

Robert S. Hogg, PhD

Faculty of Health Sciences, Simon Fraser University, Vancouver, British Columbia, Canada, B.C. Centre for Excellence in HIV/AIDS, Vancouver, British Columbia, Canada

Background. Since the advent of highly active antiretroviral therapy (HAART), AIDS-related hospitalizations have decreased. The objective of this study was to assess the impact of adherence on hospitalization among antiretroviral-naïve HIV-infected persons initiating HAART. Methods. Analysis was based on a cohort of individuals initiating HAART between 1996 and 2001. The primary outcome was hospitalization for one or more days. Survival methods were used to assess the impact of adherence on hospitalization. Results. Of 1605 eligible participants, 672 (42%) were hospitalized for one or more days after initiating HAART. Median adherence levels were 92 (IQR: 58, 100) and 100 (IQR: 83, 100) among those ever and never hospitalized, respectively. After controlling for confounders, those with <95% adherence had 1.88 times (95% CI: 1.60, 2.21) higher risk for hospitalization. Conclusions. Suboptimal adherence among HIV-infected patients taking HAART predicts hospitalization. Identifying and addressing factors contributing to poor adherence early in treatment could improve patient care and lower hospitalization costs.

Key Words: HIV • AIDS • hospitalization • HAART • adherence

This version was published on September 1, 2008

Journal of the International Association of Physicians in AIDS Care (JIAPAC), Vol. 7, No. 5, 238-244 (2008)
DOI: 10.1177/1545109708323132


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