Trajectories of Antiretroviral Therapy Adherence and Virologic Failure in Women With HIV in the United States

Author:

Elbur Abubaker Ibrahim1,Ghebremichael Musie2,Konkle-Parker Deborah3,Jones Deborah L.4,Collins Shelby5,Adimora Adaora A.6,Schneider Michael F.7,Cohen Mardge H.8,Tamraz Bani9,Plankey Michael10,Wilson Tracey11,Adedimeji Adebola12,Haberer Jessica13,Jacobson Denise L.14

Affiliation:

1. Center for Global Health, Massachusetts General Hospital, Boston, MA;

2. The Ragon Institute of MGH, MIT, and Harvard, Cambridge, MA;

3. Schools of Nursing, Medicine and Population Health, University of Mississippi Medical Center, Jackson, MS;

4. Department of Psychiatry & Behavioral Sciences, University of Miami Miller School of Medicine, Miami, FL;

5. Emory University School of Medicine, Division of Infectious Disease, Atlanta, GA;

6. Department of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC;

7. Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore;

8. Department of Medicine, Stroger Hospital of Cook County, Chicago IL;

9. University of California, San Francisco, School of Pharmacy, San Francisco, CA, MA;

10. Georgetown University Medical Center, Department of Medicine, Division of General Internal Medicine, Washington DC;

11. School of Public Health, SUNY Downstate Health Sciences University, Brooklyn, NY;

12. Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, NY;

13. Center for Global Health, Massachusetts General Hospital, Boston, MA; and

14. Center for Biostatistics in AIDS Research, Harvard T. H. Chan School of Public Health, Boston, MA.

Abstract

Background: Women with HIV (WHIV) in the United States face many challenges with adherence to antiretroviral therapy (ART), and suboptimal adherence often leads to virologic failure. This study aimed to determine the association between ART adherence trajectories and the risk of virologic failure. Methods: We included WHIV (aged 18 years or older) enrolled in the Women's Interagency HIV Study in the United States from April 2014 to September 2019 who had at least 2 consecutive measurements of HIV RNA and ≥3 measurements of self-reported adherence. Group-based trajectory modeling was used to identify adherence trajectories. Cox proportional hazard ratios were used to measure the association. Main Outcome Measure: Virologic failure was defined as HIV RNA ≥200 copies/mL at 2 consecutive visits. Results: We included 1437 WHIV (median age 49 years). Of all women, 173 (12.0%) experienced virologic failure. Four adherence trajectories were identified, namely “consistently high” (26.3%), “moderate increasing” (9.5%), “moderate decreasing” (30.6%), and “consistently low” (33.5%). Women in the consistently low adherence group consumed alcohol and experienced depression more than other groups. Compared with the “consistently high” trajectory, the risk of virologic failure was higher among women with “consistently low” [adjusted hazard ratio (aHR) 2.8; 95% confidence interval (CI): 1.6 to 4.9; P < 0.001] and “moderate decreasing” adherence trajectories (aHR 1.8; 95% CI: 1.0 to 3.2; P = 0.04), but it was similar to those with “moderate increasing” adherence trajectory (aHR 1.0; 95% CI: 0.4 to 2.5; P = 0.94). Conclusions: Adherence to ART remains a challenge among WHIV. Multilevel behavioral interventions to address poor adherence, alcohol consumption, and depression are needed.

Publisher

Ovid Technologies (Wolters Kluwer Health)

Subject

Pharmacology (medical),Infectious Diseases

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