The Combined Effect of Modern Highly Active Antiretroviral Therapy Regimens and Adherence on Mortality Over Time

The current longitudinal study characterized the impact of adherence on survival in treatment-na?ve patients initiating currently recommended highly active antiretroviral therapy (HAART) regimens.

The study focused on 903 patients who had initiated HAART between January 2000 and November 2004, following them until November 2005. The HAART regimens contained efavirenz, nevirapine, or ritonavir-boosted atazanavir or lopinavir.

Among the study participants, all-cause mortality was 11 percent, and individual adherence significantly decreased over the study period. The mean adherence level declined from 79 percent within the first six months after initiating HAART to 72 percent in the 24- to 30-month period (P value<0.01). Over time, non-adherence (<95 percent) was strongly associated with higher mortality risk (hazard ratio: 3.13; 95 percent confidence interval [CI]: 1.95-5.05). Non-adherent patients taking nonnucleoside reverse transcriptase inhibitor (NNRTI)-based and boosted protease inhibitor-based regimens were, respectively, 3.61 times (95 percent CI: 2.15-6.06) and 3.25 times (95 percent CI: 1.63-6.49) more likely to die compared with patients who adhered to their regimens. Within the cohort taking NNRTI-based regimens, non-adherent patients on efavirenz were at a higher risk of mortality.

"Incomplete adherence to modern HAART over time was strongly associated with increased mortality, and patients on efavirenz-based NNRTI therapies were particularly at a higher risk if non-adherent," the study authors concluded. "These results highlight the need to develop further strategies to help sustain high levels of adherence on a long-term basis."

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