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A Prospective Study of Adherence and Virologic Failure in HIV-Infected Patients: Role of a Single Determination of Plasma Levels of Antiretroviral Medications

Department of Physiology, University of León, León, Spain

Luis Ortega Valín, PhD

Pharmacy Service, León Hospital, León, Spain

María del Rosario Pérez-Simón, PhD

Pharmacy Service, León Hospital, León, Spain, Internal Medicine Service, León Hospital, León, Spain

José Luis Mostaza Fernández, MD

Internal Medicine Service, León Hospital, León, Spain

Manuel Alcoba Leza, MD

Internal Medicine Service, León Hospital, León, Spain

Vicente Martin Sánchez, PhD

Department of Physiology, University of León, León, Spain, vmars{at}unileon.es

the HAART Adherence Working Group of the Province of Léon, Spain

This study explores the contribution of a single determination of plasma levels for measuring adherence by means of forecasting virologic failure. Adherence was measured by questionnaires, punctuality at appointments to withdraw drugs, and plasma levels. Virologic failure was considered when 2 detectable consecutive viral loads were observed in 2 consecutive determinations with at least 1 month between them. Univariant analysis, logistic regression, and receiver operating characteristic curves were carried out. In 29 cases, virologic failure was observed. The lowest incidence was found in patients considered adherent by plasma levels and highest in those who declared nonfulfillment. The combination of methods increased the association of the incidence of virologic failure with nonadherence. The use of questionnaires plus pharmacy information implies a gain in sensitivity and a slight loss of specificity. There is a high incidence of virologic failure in these patients and a strong link with their classification as nonadherent with methods such as questionnaires and pharmacy collection information. Plasma levels do not contribute much to the prediction of virologic failure.

Key Words: adherence • antiretroviral medications • questionnaires • pharmacy • plasma levels

References

• Panel on Clinical Practices for Treatment of HIV. Guidelines for the Use of Antiretroviral Agents in HIV-1-Infected Adults and Adolescents, October 10, 2006. http://aidsinfo.nih.gov/Guidelines/GuidelineDetail.aspx?MenuItem=Guidelines&Search=Off&GuidelineID=7&ClassID=1. Accessed December 2005.
• Liu H., Golin CE, Miller LG, et al. A comparison study of multiple measures of adherence to HIV protease inhibitors . Ann Intern Med. 2001;134: 968-977 .[Abstract/Free Full Text]
• Knobel H., Alonso J., Casado JL, et al. Validation of a simplified medication adherence questionnaire in a large cohort of HIV-infected patients: the GEEMA Study . AIDS. 2002;16: 605-613 .[CrossRef][Medline] [Order article via Infotrieve]
• Alcoba M., Cuevas MJ, Perez-Simón MR, et al. Assessment of adherence to triple antiretroviral treatment including indinavir: role of the determination of plasma levels of indinavir . J Acquir Immune Defic Syndr. 2003;33: 253-258 .[CrossRef][Medline] [Order article via Infotrieve]
• Gordillo V., del Amo J., Soriano V., Gonzalez-Lahoz J. Socio-demographic and psychological variables influencing adherence to antiretroviral therapy . AIDS. 1999;13: 1763-1769 .[CrossRef][Medline] [Order article via Infotrieve]
• Marzolini C., Telenti A., Buclin T., Biollaz J., Decosterd LA Simultaneous determination of the HIV protease inhibitors indinavir, amprenavir, saquinavir, ritonavir, nelfinavir and the non-nucleoside reverse transcriptase inhibitor efavirenz by high-performance liquid chromatography after solid-phase extraction . J Chromatogr. 2000;740: 43-58 .[CrossRef][Medline] [Order article via Infotrieve]
• Hsu A., Granneman GR, Cao G., et al. Pharmacokinetic interaction between ritonavir and indinavir in healthy volunteers . Antimicrob Agents Chemother. 1998;42: 2784-2791 .[Abstract/Free Full Text]
• Dean AD, Dean JA, Coulombier D., et al. Epi Info, version 6: A word processing, database, and statistics program for epidemiology on microcomputers. Atlanta, Ga: Centers for Disease Control and Prevention; 1994.
• Dean AG, Arner TG, Sangam S., et al. Epi Info 2000, a database and statistics program for public health professionals for use on Windows 95, 98, NT, and 2000 computers. Atlanta, Ga: Centers for Disease Control and Prevention; 2000.
• Xunta de Galicia y Organización Panamericana de Salud. Epidat 2.1. Programa Para el Análisis de Datos Tabulados. Santiago de Compostela , Spain: Xunta de Galicia y Organización Panamericana de Salud; 1998.
• Paterson DL, Swindells S., Mohr J. Adherence to protease inhibitor therapy and outcomes in patients with HIV infection . Ann Intern Med. 2000;133: 21-30 .[Abstract/Free Full Text]
• Descamps D., Flandre P., Calvez V. Mechanisms of virologic failure in previously untreated HIV-infected patients from a trial of induction-maintenance therapy. Trilege (Agence Nationale de Recherches sur la SIDA 072) Study Team . JAMA. 2000;283: 205-211 .[Abstract/Free Full Text]
• Havlir DV, Hellman NS, Petropoulos PJ Drug susceptibility in HIV infection after viral rebound in patients receiving indinavir-containing regimens . JAMA. 2000;283: 229-234 .[Abstract/Free Full Text]
• González de Requena D., Gallego O., de Mendoza C., Corral A., Jiménez-Nacher I., Soriano V. Indinavir plasma concentrations and resistance mutations in patients experiencing early virologic failure . AIDS Res Hum Retroviruses. 2003;19: 457-459 .[CrossRef][Medline] [Order article via Infotrieve]
• Le Moing V., Peytavin G., Journot V., et al. Antiprotease Cohort (APROCO) Study Group. Plasma levels of Indinavir and Nelfinavir at time of virologic response may have a different impact on the risk of further virologic failure in HIV-infected patients . J Acquir Immune Defic Syndr. 2003;34: 497-499 [CrossRef][Medline] [Order article via Infotrieve]
• Martin J., Escobar I., Rubio R., Sabugal G., Cascon J., Pulido F. Study of the validity of a questionnaire to assess the adherence to therapy in patients infected by HIV . HIV Clin Trials. 2001;2: 31-37 .[CrossRef][Medline] [Order article via Infotrieve]
• Sing N., Berman SM, Swindells S., et al. Adherence of human immunodeficiency virus-infected patients to antiretroviral therapy . Clin Infect Dis. 1999;29: 824-830 .[Medline] [Order article via Infotrieve]
• Choo PW, Rands CS, Inui TS, et al. Validation of patients reports, automated pharmacy records and pill counts with electronic monitoring of adherence to antihypertensive therapy . Med Care. 1999;37: 846-857 .[CrossRef][Medline] [Order article via Infotrieve]
• Burger D., Hugen P., Reiss P., et al. for the Athena Cohort Study Group. Therapeutic drug monitoring of nelfinavir and indinavir in treatment-naïve HIV-1-infected individuals . AIDS. 2003;17: 1157-1165 .[CrossRef][Medline] [Order article via Infotrieve]
• Alexander CS, Asselin JJ, Ting LS, et al. Antiretroviral concentrations in untimed plasma samples predict therapy outcome in a population with advanced disease . J Infect Dis. 2003;188: 541-548 .[CrossRef][Medline] [Order article via Infotrieve]
• Liechty C., Alexander C., Harrigan P., et al. Are untimed antiretroviral drug levels useful predictors of adherence behavior? AIDS. 2004;18: 127-128 .[CrossRef][Medline] [Order article via Infotrieve]
• Duong M., Piroth L., Peytavin G., et al. Value of patient self-report and plasma human immunodeficiency virus protease inhibitor level as markers of adherence to antiretroviral therapy: relationship to virologic response . Clin Infect Dis. 2001; 33: 386-392 .[CrossRef][Medline] [Order article via Infotrieve]
• Escobar I., Knobel H., Polo R., et al. Recomendaciones GESIDA/ SEFH/PNS para mejorar la adherencia al tratamiento antirretroviral en el año 2004 . Farm Hosp. 2004;28(suppl 1): 6-18 .[Medline] [Order article via Infotrieve]
• Liu H., Miller LG, Hays RD, et al. Repeated measures longitudinal analyses of HIV virologic response as a function of percent adherence, dose timing, genotypic sensitivity, and other factors . J Acquir Immune Defic Syndr. 2006;41: 315-322 .[CrossRef][Medline] [Order article via Infotrieve]
• Liu H., Miller LG, Hays RD, et al. A comprehensive evaluation of survey questions for adherence to antiretroviral medications and exploratory analyses for identifying optimal sets of survey questions . AIDS Patient Care STDs. 2006;20: 760-772 .[CrossRef][Medline] [Order article via Infotrieve]
• Pérez-Simón MR, Cuevas MJ, Ortega L., et al. Valoración de la adhesión al tratamiento antirretroviral: papel de la determinación de la concentración plasmática de los fármacos no análogos de nucleósidos . Med Clin (Barc). 2003;120: 701-703 .[CrossRef][Medline] [Order article via Infotrieve]

This version was published on December 1, 2007

Journal of the International Association of Physicians in AIDS Care (JIAPAC), Vol. 6, No. 4, 245-250 (2007)
DOI: 10.1177/1545109707305444


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This Article Abstract Free Full Text (Free PDF) Free Alert me when this article is cited Alert me if a correction is posted Citation Map Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Add to Saved Citations Download to citation manager Request Permissions Request Reprints Add to My Marked Citations Citing Articles Citing Articles via Google Scholar Citing Articles via Scopus Google Scholar Articles by Cuevas González, M. J. Search for Related Content PubMed PubMed Citation Articles by Cuevas González, M. J. Social Bookmarking                         What's this?