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Multiple Characteristics of HAART Affect Adherence Described
Reported by Jules Levin
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The total number of pills taken daily in HAART therapy has the greatest
impact on adherence, according to the Perspectives on Adherence and
Simplicity for HIV-Positive Patients on Antiretroviral Therapy (PASPORT)
survey. The findings were presented in October at the annual meeting of the
Infectious Diseases Society of America (IDSA).
The survey covered 299 patients, the majority of whom had been on HAART
regimens for four years or more. Of the 10 attributes evaluated, total pills
per day had the greatest impact on adherence, followed by dosing frequency,
adverse events, diet restrictions, pill size, number of refills, number of
insurance co-pays, number of prescriptions, number of medication bottles, and
the requirement of bedtime dosing.
"In the past, studies have looked primarily at one or two factors related to
adherence and measured their impact as single entities," said Valerie Stone,
MD, MPH, lead investigator and associate chief, general medicine unit,
department of medicine at Massachusetts General Hospital. She is also an
associate professor of medicine at Harvard Medical School-Boston. "In the
PASPORT survey, we used an adaptive conjoint methodology, sometimes called
'trade off' analysis, which reflects the reality of making HIV treatment
decisions as patients consider various trade-offs to tailor a regimen that
fits their lifestyles and preferences." The survey shows that patients
preferred a regimen of two small pills dosed at the same time each day with
no food requirements or restrictions, an "acceptable" adverse event profile,
and one prescription refilled monthly with one co-pay.
This study was I think sponsored by Glaxo, thus 2 pills twice daily is
preferable which is Trizivir. Still, total pill count and easy dosing is
preferable by patients and encourages adherence. My sense is that patients
would prefer once daily dosing with as few pills as possible. But,
prospective studies are needed to truely understand if once daily dosing is
in effect preferable and more effective compared to twice daily dosing. In
effect, dosing may be better decided upon on an individual basis. Once daily
may be effective for some individuals and twice daily may be better for some
individuals. Again, prospective studies are important to sorting these
questions out.
The survey population included patients ranging in age from 17 to 72, 76
percent of whom were males. African Americans comprised approximately 45
percent of participants, with 38 percent Caucasians, 15 percent Hispanics,
and Asian and other ethnic groups making up the remainder. Researchers
interviewed HIV-infected subjects in Seattle, San Francisco, Miami, New York,
Atlanta, and Washington. Of the 295 participants who answered a question
about their current adherence, 26 percent reported no doses missed in the
past three months; 32 percent said they had missed one or two doses; 24
percent noted three to five; 8 percent said six to eight; and 10 percent
reported missing nine or more.
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