Authors: Nellen, Jeannine¹; Nieuwkerk, Pythia²; Burger, David³; Wibaut, Mirte⁴; Gras, Luuk⁵; Prins, Jan¹

Source: AIDS Care, Volume 21, Number 7, July 2009 , pp. 842-850(9)

Publisher: Routledge, part of the Taylor & Francis Group

Abstract:

In industrialized countries, virological failure occurs more often among HIV-infected immigrant patients. Non-adherence is the most credible explanation. We compared adherence of immigrant patients with that of non-immigrant patients in the Netherlands, and investigated which method of adherence measurement is most suitable for daily use to predict virological treatment failure: testing knowledge of the current regimen, a quantitative adherence interview, pharmacy prescription refill ratio (dispensed medication divided by prescribed medication, DM/PM), and plasma drug levels. Included were 61 immigrants and 81 non-immigrants. Virological failure did occur more often in immigrants than in non-immigrants (19.7% (12/61) versus 8.6% (7/81), p=0.056), especially among previously naive patients (19.6% (11/56) versus 0% (0/54), p<0.01). There were no differences between both groups on any of the four adherence measures. Virological failure was associated with reporting stopping medication when not feeling well (OR=12, 95%CI=1.9-77.7, p=0.02), and, among naive patients, also with a DM/PM < 0.85 (Odds Ratio=5.1, 95%Confidence Interval=1.2-22.3, p=0.03). Although our study confirmed a much higher virological failure rate among immigrants, we were unable to identify clear differences in adherence between immigrants and non-immigrant patient, although virological failure was associated with stopping medication when not feeling well and a low DM/PM. Unstructured treatment interruptions are a likely explanation of the findings. Interventions should be aimed at preventing patients to stop medication. A DM/PM below 0.85 can be indicative for patients who did stop medication and are at risk for virological failure.

Keywords: antiretroviral therapy; adherence; migrants

Document Type: Research article

DOI: http://dx.doi.org/10.1080/09540120802612816

Affiliations: 1: Department of Internal Medicine, Division of Infectious Diseases, Tropical Medicine and AIDS, and Centre for Infection and Immunity Amsterdam (CINIMA), Academic Medical Centre, University of Amsterdam, Amsterdam, the Netherlands 2: Department of Medical Psychology, University of Amsterdam, Amsterdam, the Netherlands 3: Department of Clinical Pharmacy, Radboud University Nijmegen Medical Center and Nijmegen University Center for Infectious diseases, Nijmegen, the Netherlands 4: Academic Medical Center, University of Amsterdam, Amsterdam, the Netherlands 5: Dutch HIV Monitoring Foundation, Amsterdam, the Netherlands

Publication date: 2009-07-01

More about this publication?

• Editorial Board
• Information for Authors
• Subscribe to this Title
• ingentaconnect is not responsible for the content or availability of external websites

Related content

• In this: publication
• By this: publisher
• In this Subject: Allergy & Immunology ,  Public Health
• By this author: Nellen, Jeannine ;  Nieuwkerk, Pythia ;  Burger, David ;  Wibaut, Mirte ;  Gras, Luuk ;  Prins, Jan

Website © Publishing Technology. Article copyright remains with the publisher, society or author(s) as specified within the article.

• Terms and conditions
• Privacy policy
• Information for advertisers