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Effect of Medication Adherence on Survival of HIV-Infected Adults Who Start Highly Active Antiretroviral Therapy When the CD4+ Cell Count Is 0.200 to 0.350 × 109 cells/L

Evan Wood, PhD; Robert S. Hogg, PhD; Benita Yip, BSc (Pharm); P. Richard Harrigan, PhD; Michael V. O'Shaughnessy, PhD; and Julio S.G. Montaner, MD, FRCPC
[+] Article and Author Information

From St. Paul's Hospital and University of British Columbia, Vancouver, British Columbia, Canada.


Acknowledgments: The authors thank Bonnie Devlin, Elizabeth Ferris, Nada Gataric, Kelly Hsu, Myrna Reginaldo, Chandra Lips, and Peter Vann for their research and administrative assistance and Kathy Li, Kevin Craib, and Martin Schechter for their advice on the statistical methods.

Grant Support: Evan Wood is supported by the Michael Smith Foundation for Health Research. Robert Hogg is supported by the Michael Smith Foundation for Health Research through a Career Investigator Award and by Canadian Institutes of Health Research through an Investigator Award.

Potential Financial Conflicts of Interest:Honoraria: R.S. Hogg (AIDS Research Program, St. Paul's Hospital); Grants received: J.S.G. Montaner (Abbott Laboratories, Agouron Pharmaceuticals, Shire Biochem, Boehringer Ingelheim Pharmaceuticals, Belgium International GmbH, Bristol-Myers Squibb, DuPont Pharma, Gilead Sciences, Glaxo Wellcome, Hoffman-LaRoche, Kucera Pharmaceutical Co., Merck Frosst Laboratories, Pharmacia & Upjohn, Trimeris); Patents received: J.S.G. Montaner (PCT/EP 02/.05151: Co-inventor, along with Boehringer Ingelheim International GmbH, of “Use of nevirapine to treat or prevent lipid abnormalities in patients with HIV that is resistant to nevirapine”); Patents pending: J.S.G. Montaner (PCT/CA02/00796: “Pharmacological applications of mitochondrial DNA assays,” filed 29 May 2002; U.S. patent application for “Pharmacological applications of mitochondrial DNA analysis,” filed 29 May 2002; U.S. provincial application for “Sepsis”).

Requests for Single Reprints: Julio S.G. Montaner, MD, FRCPC, AIDS Research Program, University of British Columbia/St. Paul's Hospital, 667-1081 Burrard Street, Vancouver, British Columbia V6Z 1Y6, Canada; e-mail, jmontaner@hivnet.ubc.ca.

Current Author Addresses: Drs. Wood, Hogg, Harrigan, O'Shaughnessy, and Montaner and Ms. Yip: University of British Columbia/St. Paul's Hospital, 667-1081 Burrard Street, Vancouver, British Columbia V6Z 1Y6, Canada.

Author Contributions: Conception and design: E. Wood, R.S. Hogg, B. Yip, J.S.G. Montaner.

Analysis and interpretation of the data: E. Wood, R.S. Hogg, B. Yip, J.S.G. Montaner.

Drafting of the article: E. Wood, R.S. Hogg, B. Yip, P.H. Harrigan, J.S.G. Montaner.

Critical revision of the article for important intellectual content: E. Wood, R.S. Hogg, B. Yip, P.H. Harrigan, M.V. O'Shaughnessy, J.S.G. Montaner.

Final approval of the article: E. Wood, R.S. Hogg, M.V. O'Shaughnessy, J.S.G. Montaner.

Statistical expertise: E. Wood, M.V. O'Shaughnessy.

Obtaining of funding: R.S. Hogg, M.V. O'Shaughnessy, J.S.G. Montaner.

Administrative, technical, or logistic support: E. Wood, R.S. Hogg, B. Yip, P.H. Harrigan, M.V. O'Shaughnessy, J.S.G. Montaner.

Collection and assembly of data: B. Yip.


Ann Intern Med. 2003;139(10):810-816. doi:10.7326/0003-4819-139-10-200311180-00008
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The HAART Observational Medical Evaluation and Research (HOMER) study, conducted through the British Columbia Centre for Excellence in HIV/AIDS Drug Treatment Program, has been described in detail elsewhere (7, 17). Briefly, the Centre is the only free source of antiretroviral medications in British Columbia, Canada; pharmaceutical sales suggest that less than 1% of HIV-infected patients in this province obtain antiretroviral agents outside the program (18). For all participants, the program maintains a complete prospective profile of antiretroviral therapy.

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Figures

Grahic Jump Location
Figure 1.
Cumulative all-cause mortality stratified by baseline CD4+ cell count and 75% adherence.

The number of patients at risk at each subsequent time interval decreases because of events or limited follow-up. HAART = highly active antiretroviral therapy.

Grahic Jump Location
Grahic Jump Location
Figure 2.
Cumulative mortality with accidents censored as nonevents stratified by baseline CD4+ cell count and 95% adherence.

The number of patients at risk at each subsequent time interval decreases because of events or limited follow-up. HAART = highly active antiretroviral therapy.

Grahic Jump Location

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Summary for Patients

Importance of Routinely Taking Drug Therapy for HIV-1 Infection

The summary below is from the full report titled “Effect of Medication Adherence on Survival of HIV-Infected Adults Who Start Highly Active Antiretroviral Therapy When the CD4+ Cell Count Is 0.200 to 0.350 × 109 cells/L.” It is in the 18 November 2003 issue of Annals of Internal Medicine (volume 139, pages 810-816). The authors are E. Wood, R.S. Hogg, B. Yip, P.R. Harrigan, M.V. O'Shaughnessy, and J.S.G. Montaner.

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