Objective: To characterize the impact of hepatitis C (HCV) serostatus on adherence to antiretroviral treatment (ART) among HIV-infected adults initiating ART.
Methods: The British Columbia HIV/AIDS Drug Treatment Program distributes, at no cost, all ART in this Canadian province. Eligible individuals used triple combination ART as their first HIV therapy and had documented HCV serology. Statistical analyses used parametric and non-parametric methods, including multivariate logistic regression. The primary outcome was ≥ 95% adherence, defined as receiving ≥ 95% of prescription refills during the first year of antiretroviral therapy.
Results: There were 1186 patients eligible for analysis, including 606 (51%) positive for HCV antibody and 580 (49%) who were negative. In adjusted analyses, adherence was independently associated with HCV seropositivity [adjusted odds ratio (AOR), 0.48; 95% confidence interval (CI), 0.23–0.97; P = 0.003], higher plasma albumin levels (AOR, 1.07; 95% CI, 1.01–1.12; P = 0.002) and male gender (AOR, 2.53; 95% CI, 1.04–6.15; P = 0.017), but not with injection drug use (IDU), age or other markers of liver injury. There was no evidence of an interaction between HCV and liver injury in adjusted analyses; comparing different strata of HCV and IDU confirmed that HCV was associated with poor adherence independent of IDU.
Conclusions: HCV-coinfected individuals and those with lower albumin are less likely to be adherent to their ART.
From the aBritish Columbia Center for Excellence in HIV/AIDS
bDepartment of Health Care and Epidemiology
cDepartment of Counseling Psychology
dDepartment of Medicine, University of British Columbia, Vancouver, Canada
eInstitute of Social and Preventive Medicine, University of Bern, Bern, Switzerland
fYale University School of Medicine and New Haven VA Connecticut Healthcare System, West Haven, Connecticut
gUniversity of California–San Francisco AIDS Research Institute, USA.
Received 6 June, 2005
Revised 23 September, 2005
Accepted 3 October, 2005
Correspondence to Dr P. Braitstein, Institute of Social and Preventive Medicine, University of Bern, Finkenhubelweg 11, Bern CH-3012, Switzerland. E-mail: firstname.lastname@example.org