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Title: Predictors of adherence and virologic outcome in HIV-infected patients treated with abacavir- or indinavir-based triple combination HAART also containing lamivudine/zidovudine
Authors: Pedro Cahn
Asda Vibhagool
Mauro Schechter
Luis Soto-Ramirez
Giampiero Carosi
Fiona Smaill
Jamie C. Jordan
Cristina E. Pharo
Nicola E. Thomas
Helen M. Steel
Fundacion Huesped
Mahidol University
Universidade Federal do Rio de Janeiro
Instituto Nacional de la Nutricion Salvador Zubiran
Universita degli Studi di Brescia
McMaster University Medical Centre
GlaxoSmithKline, USA
GlaxoSmithKline plc, United Kingdom
Keywords: Medicine
Issue Date: 1-Jul-2004
Citation: Current Medical Research and Opinion. Vol.20, No.7 (2004), 1115-1123
Abstract: Objectives: To compare dosing convenience and adherence with abacavir (ABC) 300 mg plus a fixed-dose lamivudine 150 mg/zidovudine 300 mg combination tablet (COM) twice daily versus indinavir (IDV) plus COM twice daily in treatment-naïve, HIV-1-infected adults; and to evaluate the association among difficulty taking antiretroviral regimens, adherence, and virologic efficacy. Methods: An open-label, randomized, multicenter, international study compared the COM/ABC and IDV/COM regimens with respect to self-reported adherence and regimen convenience over 48 weeks. Logistic regression analysis (LRA) was done on a patient sub-sample from both groups to evaluate predictors of adherence and virologic response at last time-point on randomized therapy (LTORT). Results: The study population was diverse with respect to ethnicity (38% Asian, 27% Hispanic, 28% white, 3% black, 4% other) and gender (39% women, 61% men). Baseline median HIV-1 RNA was 4.80 log10copies/mL and CD4+ cell count was 315 cells/mm3. Of 329 patients who were randomized and received treatment, 315 (96%) provided adherence data. Significantly more patients in the ABC/COM group than in the IDV/COM group reported ≥ 95% adherence to therapy (76 vs 58%, p < 0.001) and no difficulty in taking their regimen (91 vs 61%, p < 0.001). In both groups, the highest probability of HIV-1 RNA < 400 copies/mL occurred when median adherence was ≥ 95%. The probability of HIV-1 RNA < 400 copies/mL declined more rapidly in the IDV/COM group as adherence rates decreased. LRA showed that no difficulty taking any of the drugs in the regimen, ABC/COM treatment group, and male gender were independent significant predictors of ≥ 95% adherence (p < 0.05). Median adherence and baseline HIV-1 RNA were significant predictors of HIV-1 RNA < 400 copies/mL (p < 0.05). Conclusions: Patients reported greater ease of use and superior adherence to ABC/COM than IDV/COM. Patient-reported difficulty taking drugs in a regimen was predictive of reduced adherence, and both of the latter factors were predictive of poorer virologic outcome. Adherence levels of ≥ 95% in both treatment groups maximized the probability of patients achieving an HIV-1 RNA < 400 copies/mL.
ISSN: 03007995
Appears in Collections:Scopus 2001-2005

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