Summaries for Patients |

Adherence to Nonnucleoside Reverse Transcriptase Inhibitor–Based HIV Therapy and Patient Outcomes FREE

[+] Article, Author, and Disclosure Information

The summary below is from the full report titled “Adherence to Nonnucleoside Reverse Transcriptase Inhibitor– Based HIV Therapy and Virologic Outcomes.” It is in the 17 April 2007 issue of Annals of Internal Medicine (volume 146, pages 564-573). The authors are J.B. Nachega, M. Hislop, D.W. Dowdy, R.E. Chaisson, L. Regensberg, and G. Maartens.

Ann Intern Med. 2007;146(8):I-28. doi:10.7326/0003-4819-146-8-200704170-00003
Text Size: A A A

What is the problem and what is known about it so far?

HIV is the cause of AIDS, which is a potentially deadly illness that interferes with the body's ability to fight off infection and certain types of cancer. Treatment regimens containing several drugs (called highly active antiretroviral therapy or HAART) have greatly improved outcomes for HIV-infected patients. Unfortunately, people need to have high levels of adherence to the treatment regimens for the drugs to work. Adherence means taking drugs exactly as prescribed and not missing doses. Newer treatment combinations include drugs called nonnucleoside reverse transcriptase inhibitors (NNRTIs). It is unclear whether treatment combinations that include NNRTIs require the same high level of adherence to effectively treat HIV infection as treatment combinations that do not contain these drugs. Studies of treatment combinations that did not include NNRTIs suggest that patients need to take 90% of prescribed doses to effectively suppress HIV infection.

Why did the researchers do this particular study?

To find out whether HIV treatment combinations that include NNRTIs require the same high level of adherence as regimens that do not contain these agents.

Who was studied?

2,821 HIV-infected adults who started treatment with NNRTI-containing treatment between January 1998 and March 2003. All patients were receiving health care in an HIV program in South Africa that covered the cost of the drugs.

How was the study done?

The researchers used the pharmacy computer system to determine how often the patients refilled their HIV treatment prescriptions. They also collected information on the results of blood tests for viral load. Doctors use viral load measurements to monitor patients who are receiving treatment for HIV infection. Viral load is a measure of the amount of HIV virus in the blood. It increases as the disease advances, so a lower viral load is better. The researchers considered viral load less than 400 copies/mL to be complete suppression of HIV infection, which is a good outcome.

What did the researchers find?

As adherence to prescribed drugs increased, complete suppression increased. However, some patients who took only 50% of prescribed doses had complete suppression (viral load fewer than 400 copies/mL).

What were the limitations of the study?

The researchers recorded how often patients filled their prescriptions as a way to measure how well they followed the prescribed treatment. It is possible that some patients filled their prescriptions regularly but did not take the drugs as prescribed. Also, not all patients had their viral load measured at set times in relation to when they started treatment.

What are the implications of the study?

Although outcomes are best when patients take HIV treatment exactly as prescribed, patients who receive drug combinations that include NNRTIs may have good viral load outcomes with medium adherence levels. Studies of drug combinations that do not contain NNRTIs suggest that these regimens require higher levels of adherence for good outcomes.





Citing articles are presented as examples only. In non-demo SCM6 implementation, integration with CrossRef’s "Cited By" API will populate this tab (http://www.crossref.org/citedby.html).


Submit a Comment/Letter
Submit a Comment/Letter

Summary for Patients

Clinical Slide Sets

Terms of Use

The In the Clinic® slide sets are owned and copyrighted by the American College of Physicians (ACP). All text, graphics, trademarks, and other intellectual property incorporated into the slide sets remain the sole and exclusive property of the ACP. The slide sets may be used only by the person who downloads or purchases them and only for the purpose of presenting them during not-for-profit educational activities. Users may incorporate the entire slide set or selected individual slides into their own teaching presentations but may not alter the content of the slides in any way or remove the ACP copyright notice. Users may make print copies for use as hand-outs for the audience the user is personally addressing but may not otherwise reproduce or distribute the slides by any means or media, including but not limited to sending them as e-mail attachments, posting them on Internet or Intranet sites, publishing them in meeting proceedings, or making them available for sale or distribution in any unauthorized form, without the express written permission of the ACP. Unauthorized use of the In the Clinic slide sets will constitute copyright infringement.


Want to Subscribe?

Learn more about subscription options

Related Articles
Related Point of Care
Topic Collections
PubMed Articles
Forgot your password?
Enter your username and email address. We'll send you a reminder to the email address on record.