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AIDS:
Epidemiology & Social

Intermittent use of triple-combination therapy is predictive of mortality at baseline and after 1 year of follow-up

Hogg, Robert S.a,b; Heath, Katherinea,b; Bangsberg, Davidc; Yip, Benitaa; Press, Natashaa; O'Shaughnessy, Michael V.a,d; Montaner, Julio S. G.a,e

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Author Information

From the aBC Centre for Excellence in HIV/AIDS, the bDepartment of Health Care and Epidemiology, Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada, the cEpidemiology and Prevention Interventions Center, Division of Infectious Diseases and the Positive Health Program, San Francisco General Hospital, California, USA, the dDepartment of Pathology and Laboratory Medicine, and the eDepartment of Medicine, Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada.

Requests for reprints to: R. Hogg, Division of Epidemiology and Population Health, BC Centre for Excellence in HIV/AIDS, 608-1081 Burrard Street, Vancouver, B.C. V6Z 1Y6, Canada.

Received: 12 July 2001;

revised: 20 December 2001; accepted: 7 January 2002.

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Abstract

Objective: To characterize the impact of intermittent use of triple drug antiretroviral therapy on survival.

Design, setting and participants: Population-based analysis of 1282 antiretroviral therapy naive HIV-positive individuals aged 18 years and older in British Columbia who started triple-combination therapy between August 1996 and December 1999. Therapy use was estimated by dividing the number of months of medications dispensed by the number of months of follow-up. Intermittent therapy was defined as the participant having obtained less than 75% of their medication in the first 12 months.

Main outcome measure: Cumulative all-cause mortality rates from the start of triple drug antiretroviral therapy to 30 September 2000.

Results: As of 30 September 2000, 106 subjects had died. Cumulative mortality was 3.9% (± 0.5%) at 12 months. In a multivariate model, after controlling for other variables that were significant in the univariate analyses each 100 cell decrement in baseline CD4 cell count and the intermittent use of antiretroviral drugs were associated with increased mortality with risk ratios of 1.31 [95% confidence interval (CI), 1.16–1.49;P < 0.001] and 2.90 (95% CI, 1.93–4.36;P < 0.001), respectively. In order to control for downward drift, intermittent use of therapy was measured over the first year whereas other factors were measured at the end of year 1. After adjusting for all other factors, those participants who used antiretroviral drugs intermittently were 2.97 times (95% CI, 1.33–6.62;P = 0.008) more likely to die.

Conclusion: Our study demonstrates that even after adjusting for other prognostic factors intermittent use of antiretroviral therapy was associated with increased mortality.

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Introduction

The virologic and immunologic efficacy of triple-combination antiretroviral therapy currently used in the treatment of HIV infected patients has been shown in clinical trials [1–3]. Cohort and population based studies have now confirmed the impact of triple-combination therapy in terms of reductions in AIDS-related death rates, opportunistic infections, and hospitalization [4,5].

Despite these advances, the full benefit of antiretroviral regimens as reported in clinical trials remains difficult to achieve in clinical practice due in part to imperfect adherence [6]. Incomplete adherence to antiretroviral treatment has been shown to be an important cause of premature virologic failure [7]. Patients taking antiretroviral drugs intermittently or at reduced doses often experience suboptimal drug levels thus increasing the likelihood of drug resistance [8,9]. Moreover, resistance to one drug is frequently associated with cross- resistance to other members of the same class [10,11] thus limiting future treatment options. This problem is compounded by the possibility that multidrug resistant viruses can be transmitted from HIV-positive persons on antiretroviral therapy to sexual and injecting drug user networks [6,12].

While the clinical efficacy of triple-combination antiretroviral regimens and the importance of adherence in achieving viral suppression appear well established, the long term impact of intermittent use of antiretroviral therapy on disease progression in a previously untreated population of men and women remains unclear. We undertook the present study to ascertain the impact of intermittent use of antiretroviral therapy on survival within a population based cohort with free access to medical services, including antiretroviral therapy.

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Methods

HIV/AIDS drug treatment program

The delivery of antiretroviral therapy in the province of British Columbia, Canada has been described elsewhere [5,13]. In this province, antiretroviral drugs have been centrally distributed at no cost to eligible HIV-infected individuals since 1986. In October 1992, the HIV/AIDS Drug Treatment Program became the responsibility of the British Columbia Centre for Excellence in HIV/AIDS (the Centre). The Centre's HIV/AIDS Drug Treatment Program remains the only free source of antiretroviral medications in the province and one of the few population-based HIV drug distribution systems in the world.

The Centre distributes antiretroviral medications based on specific guidelines generated by the Therapeutic Guidelines Committee. In June 1996 the Centre adopted plasma HIV-1 RNA driven antiretroviral therapy guidelines, consistent with those put forward by the International AIDS Society, USA [14]. Consistent with contemporary practice [15], the Centre guidelines were revised in July 1997 to recommend triple-combination therapy for all antiretroviral naive individuals with plasma HIV-1 RNA levels ≥ 5000 copies/ml or CD4 cell count < 500 × 106/l. The Centre recommends that plasma HIV-1 RNA levels be monitored at baseline, at 4 weeks after starting antiretroviral therapy and every 3 months thereafter.

All three classes of antiretroviral drug were available through the program during the study period including: nucleoside reverse transcriptase inhibitors, zidovudine, lamivudine, didanosine, zalcitabine, stavudine, and abacavir; protease inhibitors (PI), indinavir, nelfinavir, saquinavir, and ritonavir; and non-nucleoside reverse transcriptase inhibitors (NNRTI), delavirdine, nevirapine, and efavirenz. Plasma HIV-1 RNA was measured using the Amplicor HIV-1 Monito (Roche Diagnostic Systems, Branchburg, New Jersey, USA).

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Data collection

HIV-positive men and women are entered into the Centre's HIV/AIDS Drug Treatment Program when they are first prescribed antiretroviral agents by any physician practicing within the province. Physicians enrolling an HIV-positive individual must complete a drug request enrolment form. The form acts as a legal prescription and compiles baseline information, including the applicant's address, past HIV-specific drug history, CD4 cell counts, plasma HIV-1 RNA, current drug requests, and enrolling physician data. Each request is reviewed by a qualified physician to ensure that the prescription meets the Centre's guidelines [14]. Typically, persons receiving antiretroviral therapy are monitored by physicians at intervals no longer than 3 months at which time prescriptions are renewed or modified. At the time of the first medication refill participants are asked to provide informed consent for accessing electronic medical records (which may be used for health utilization studies, but is not relevant to the analyses in this study), and complete a participant survey, which elicits information on sociodemographic characteristics, clinical and health status, and alternative therapy use. Both the consent form and the participant survey are optional and participant's refusal to do either will not limit his or her access to free antiretroviral therapy. At the same time, the treating physicians are asked to complete a clinical staging form using the World Health Organization (WHO) clinical staging system [16]. For all program participants a complete prospective profile of antiretroviral therapy is maintained, including the medications prescribed, the amount dispensed, and the prescription fill dates.

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Outcome measures and explanatory variables

The primary endpoint in this analysis was all-cause mortality. Deaths occurring during the follow-up period were identified on a continuous basis from physician reports and through record linkages carried out with the British Columbia Division of Vital Statistics. The secondary endpoint in this analysis was a primary diagnosis of AIDS and/or death in AIDS-free subjects. As with the primary endpoint, primary AIDS diagnoses occurring over the study period were obtained either from the physician or the provincial AIDS registry.

The following baseline explanatory variables were investigated: age, sex, CD4 cell count, plasma HIV-1 RNA levels, prior AIDS diagnosis, PI use, current or past history of injecting drug use, physician experience, and intermittent therapy use. Physician experience was defined as the number of HIV-positive patients the physician had previously treated at the time the study subject was enrolled into the HIV/AIDS Drug Treatment Program. Estimates of intermittent use of antiretroviral therapy are based on medications dispensed, not prescribed. Antiretrovirals are prescribed and dispensed according to approved therapeutic guidelines. Patients receive new prescriptions at various time intervals ranging from monthly to, at most, every 3 months. For this exercise we limit our measure of intermittent use of antiretroviral drugs to the first year of therapy and estimated it by dividing the number of months’ worth of medications dispensed by the number of months of follow-up in the first 12 months, expressed as percent. Intermittent use of therapy in this study represents the gap between the time that the previous medication supply ran out until the next refill date, and/or until the last contact date with the program.

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Statistical analysis

This analysis was restricted to HIV-positive men and women who were antiretroviral naive and were first prescribed triple drug antiretroviral therapy between 1 August 1996 and 31 December 1999. Study subjects were initially prescribed triple drug combination therapy with regimens including a PI or a NNRTI. For the purposes of analysis we followed the intent-to-treat principle; thus all eligible subjects were included as they were first dispensed antiretroviral drugs regardless of whether they later discontinued or modified their therapeutic regimen.

Cumulative mortality rates were estimated using Kaplan–Meier methods. Survival curves were compared between groups with the log-rank test. Event-free subjects were right censored as of 30 September 2000. Participants included in this analysis were not followed after this date and those lost to follow-up were censored at the date of last known contact with the HIV/AIDS Drug Treatment Program.

Cox-proportional hazard regression was used to model the simultaneous effect of prognostic variables on survival [17]. In this analysis, we adjusted for a number of salient prognostic explanatory variables at baseline. The variables sex, prior AIDS diagnosis, PI use, and current or past history of injecting drug use were treated as fixed binary variables (yes versus no), age (in years) was treated as a continuous variable, and CD4 cell count (per 100 cell decrement), HIV-1 RNA levels (per log10 increment), physician experience (per 100 patients followed) and intermittent use of antiretroviral therapy (less than 75% of their medication in the first 12 months) were treated as ordinal variables. The results of our analyses were unchanged when other cut-offs for physician experience were used in this study.

We then used the magnitude of the relative hazards and their statistical significance from the Cox proportional hazard models to search for any potential thresholds in intermittent use of antiretroviral therapy. Therapy use was first divided into nine levels: 15–24%, 25–34%, 35–44%, 45–54%, 55–64%, 65–74%, 75–84%, 85–94%, and finally, ≥ 95% used as the control group. We then used the magnitude of the relative hazards and their statistical significance from the Cox proportional hazard models to search for any potential thresholds. As noted in Table 1, when this methodology was applied we observed a threshold in risk ratio at the 65–74% level of intermittent use of antiretroviral drugs, at which point the risk ratio (P = 0.092) was marginally significant when compared against the comparison group with ≥ 95% use of antiretroviral therapy. In this analysis, participants with < 75% use of antiretroviral drugs in the first year were pooled and then compared against those ≥ 75% use.

Table 1
Table 1
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A subanalysis restricted to participants with at least 1 year of follow-up was conducted to adjust for the potential confounding of downward drift (i.e., that lesser use of antiretroviral drugs in the first year may be a marker for rapid progression in this study group). In this survival analysis the first 12-month period was used to determine intermittent use according to the above mentioned cut-off and the other baseline prognostic explanatory variables (age, CD4 cell count, plasma HIV-1 RNA levels, prior AIDS diagnosis, PI use and physician experience) were measured at the end of year 1. As in the first set of analyses, both the primary and secondary outcomes were examined prospectively.

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Results

Between 1 August 1996 and 31 December 1999, a total of 1397 antiretroviral naive participants aged 18 years and over initiated triple-combination therapy consisting of two nucleoside reverse transcriptase inhibitors plus a PI or with a NNRTI. Of these, 115 (8.23%) were excluded from this analysis for not having both baseline CD4 cell counts and plasma HIV-1 RNA levels measures available within 6 months prior to the start of antiretroviral therapy. The total study sample was based on the remaining 1282 (91.8%) subjects. Study participants were less likely to be on PI (73.0%) and less likely to have a prior AIDS diagnosis (13.1%) or to be a past or current injecting drug user (21.5%) in comparison with those excluded from the analyses. The overall median follow-up time of these study subjects was 26.8 months [interquartile range (IQR), 16.5–37.2 months].

Table 2 provides the baseline characteristics of the 1282 study participants. The median age was 37 years (IQR, 32–44 years), CD4 cell count was 270 × 106/l (IQR, 130–420 × 106/l), plasma HIV-1 RNA level was 120 000 copies/ml (IQR, 38 800–310 000 copies/ml), physician experience was 45 patients per physician (IQR, 5–132 patients per physician), and therapy use was 100% (IQR, 67–100%) in the first 12 months. A total of 729 (56.9%) participants used antiretroviral therapy ≥ 95% of the time in the first year.

Table 2
Table 2
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Study participants were first prescribed 29 different triple-combination antiretroviral regimens. A total of 130 (10.1%) commenced therapy in 1996, 436 (34.0%) in 1997, 368 (28.7%) in 1998, and 348 (27.1%) in 1999. The vast majority of participants (936, 73.0%) initiated therapy with a PI. The PI used in the initial regimen included: indinavir (692, 73.9%), nelfinavir (128, 13.7%), saquinavir (79, 8.4%), and ritonavir (37, 4.0%). The rest of the study participants (346, 27.0%) had a regimen that included a NNRTI. Among these subjects, 324 (93.6%) were on nevirapine, whereas 11 (3.2%) used efavirenz and 11 (3.2%) used delavirdine.

As of 30 September 2000, a total of 106 deaths were identified in the study population; of these 22 were not attributed to AIDS. These 22 deaths included five suicides and 17 accidental drug overdoses. All-cause mortality rate was 8.3%. The product limit estimate of the cumulative mortality rate at 12 months was 3.9% (± 0.5%). Among individuals who were AIDS free at baseline, a total of 103 events were identified, 25 primary AIDS diagnoses and 78 deaths. The total number and proportion of the AIDS-defining illnesses were:Pneumocystis carinii pneumonia, eight (32.0%); other opportunistic infections, 10 (40.0%); wasting syndrome, one (4.0%); malignancies, two (8.0%); others, four (16.0%). At 12 months the product limit estimate of the likelihood of progressing to AIDS or to death was 4.9% (± 0.7%).

The univariate and multivariate analyses of the baseline factors associated with all-cause mortality are presented in Table 3. Inclusion of PI in the initial regimen, a prior diagnosis of AIDS, HIV-1 RNA levels and CD4 cell count, physician experience and intermittent use of therapy were found to be prognostic predictors of survival in the univariate analysis. Participants with a prior AIDS diagnosis at baseline were 2.13 times (95% CI, 1.37–3.32;P < 0.001) more likely to die than those without a diagnosis of AIDS. For each 100 cell decrease in CD4 cell count study participants were 1.36 times (95% CI, 1.21–1.53;P < 0.001) more likely to die; while for each log10 increase in plasma HIV-1 RNA level there was a 1.78 times (95% CI, 1.26–2.50;P < 0.001) increased risk of mortality. Those who started therapy with a PI were 2.09 times more likely to die than those who did not (95% CI, 1.14–3.84;P = 0.017). Patients visiting a more experienced physician (by 100 HIV patient increments) had a reduced risk of mortality [relative risk (RR), 0.76; 95% CI, 0.59–0.98;P = 0.037). For intermittent use of therapy in the first year, those who used therapy < 75% of the time were 2.35 times (95% CI, 1.60–3.46;P < 0.001) more likely to die than those participants who used antiretroviral therapy ≥ 75% of the time.

Table 3
Table 3
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In the multivariate model, only CD4 cell count, and intermittent use of antiretroviral therapy were found to be independent predictors of survival. After controlling for other prognostic explanatory variables that were significant in the univariate analyses (plasma HIV-1 RNA levels, prior AIDS diagnosis, PI use and physician experience), each 100 cell decrement in CD4 cell count and intermittent use of antiretroviral therapy (< 75% of the time in the first year) were associated with increased mortality with risk ratios of 1.31 (95% CI, 1.16–1.49;P < 0.001) and 2.90 (95% CI, 1.93–4.36;P < 0.001), respectively.

All relevant analyses were repeated with the time from the start of antiretroviral therapy to a diagnosis of AIDS or death as the outcomes of interest. These analyses were restricted to 1114 participants who were AIDS free at baseline. After adjusting for all other prognostic factors the results were unchanged when AIDS-free survival was used as the primary outcome. In this case, participants who used antiretroviral drugs < 75% of the time in the first year were 2.99 times (95% CI, 2.00–4.47;P < 0.001) more likely to die or to get an AIDS-defining illness.

Finally, we repeated all relevant analyses restricted to participants with at least 1 year of follow-up. As noted above, the aim of this subanalysis was to adjust for the potential confounding of downward drift by measuring intermittent therapy use in the first year and measuring other prognostic baseline factors (age, sex, CD4 cell count, plasma HIV-1 RNA levels, prior AIDS diagnosis, PI use, current or past history of injecting drug use, and physician experience) at the end of the first year. A total of 1119 (87.3%) of the 1282 study participants had at least 1 year of follow-up. Of these, 272 (24.3%) were excluded from this subanalysis for not having both baseline CD4 cell count and plasma HIV-1 RNA level data available within 6 months prior to the start of year 1. Subjects excluded were younger (median, 36 versus 38 years;P = 0.001), less likely to be male (75.7% versus 87.8%;P = 0.001), and visited less experienced physicians (median experience, 23 versus 54 patients;P < 0.001) than those in the subanalysis. However, we did not observe any differences in the use of PI, injecting drug use, diagnosis of AIDS, baseline CD4 cell count or HIV-plasma viral load between these two groups. The total subanalysis study sample was based on the remaining 847 (75.7%) subjects. The overall median follow-up time of these study subjects, with time zero shifted to 1 year from the start of antiretroviral drugs, was 18 months (IQR, 8–26 months).

Kaplan-Meier product limit estimates of cumulative progression to death among 847 HIV-positive subjects who had at least 12 months of follow-up and started naïve on antiretroviral therapy are highlighted in Fig. 1. Of the 847 participants with at least 1 year of follow-up, 683 (80.6%) used antiretroviral drugs for ≥ 75% of the time in the first year. The product limit estimate of all-cause mortality at 12 months was 1.91% (± 0.57%) for those who used antiretroviral drugs for ≥ 75% of the time and 10.57% (± 2.6%) for those who did not (log rank P < 0.001). In univariate analyses, those who used antiretroviral drugs for < 75% of the time in this 12 month period were 4.83 times [95% confidence interval (CI), 2.57–9.06;P < 0.001] more likely to die than those participants who used therapy for ≥ 75% of the time.

Fig. 1
Fig. 1
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As indicated in Table 4, the results of our all-cause mortality survival analysis remained unchanged. After adjusting for all other prognostic factors, those participants who used antiretroviral drugs < 75% of the time in the first year were 2.97 times (95% CI, 1.33–6.62;P = 0.008) more likely to die. The results of the multivariate analyses remained unchanged when AIDS-free survival was used as the outcome.

Table 4
Table 4
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Discussion

Our results demonstrate that intermittent use of antiretroviral therapy is associated with increased mortality. Similar results were found when we considered AIDS-free survival. After controlling for other prognostic explanatory variables that were significant in the univariate analyses each 100 cell decrement in CD4 cell count and intermittent use of antiretroviral drugs (< 75% of the time in the first year) were associated with increased mortality with risk ratios of 1.31 (95% CI, 1.16–1.49;P < 0.001) and 2.90 (95% CI, 1.93–4.36;P < 0.001), respectively. The results were similar when the analysis was restricted to persons with at least 1 year of follow-up and when intermittent use of therapy was measured in the first year while all other prognostic explanatory variables were measured at the end of year 1. Besides intermittent therapy use, CD4 cell counts at baseline were the only other significant independent predictors of mortality in this analysis.

A novel finding of our study was that intermittent use of antiretroviral therapy was positively associated with mortality. These results are consistent with what has been observed with durable response to therapy in clinical and observational settings among persons infected with HIV. The results of clinical trials and clinical studies indicate that near perfect adherence in the range of 90–100% may be necessary to achieve and maintain durable suppression of viral replication among persons using triple-combination antiretroviral therapy [18–20]. In our study population we have previously demonstrated a positive linear relationship between intermittent use as estimated in this fashion and achievement of viral suppression [21]. Similarly, in an indigent population in San Francisco the level of adherence to antiretroviral therapy was closely associated with longitudinal viral suppression and the rate of subsequent disease progression [22].

Our study confirms low CD4 cell count as a key marker of disease progression, especially death [23–26]. Our data also indicate that plasma HIV-1 RNA alone was not an independent predictor of survival among patients initiating triple-combination antiretroviral therapy. These findings appear to conflict with current published natural history studies and guidelines for the initiation of therapy. We would propose that these differences are easy to reconcile based on the fact that previous natural history studies were conducted in untreated cohorts [27–30]. Plasma HIV-1 RNA levels are likely to lose their prognostic value if treatment is similarly able to decrease plasma HIV-1 RNA levels across each CD4 cell count stratum. This is consistent with what we reported previously in Durban, South Africa [31] and has been confirmed by other cohort studies in the USA and Europe this year [32–34]. Finally, it was reassuring to observe no difference in survival according to age, sex, injecting drug use, physician experience and between those who initiated triple therapy with a PI versus those using a NNRTI.

There are several important aspects of this study that should be highlighted. First, our study was carried out within a province-wide treatment program where all individuals had free access to medical attention, combination antiretroviral therapy, and laboratory monitoring free of charge. Therefore, we believe that issues related to access to therapy do not compromise our results. Second, this study was based on treatment naive individuals, thus our results are not confounded by any past antiretroviral use. Also, all patients received triple drug therapy consistent with current guidelines. Third, delayed reporting does not play a role in these analyses as the vast majority of deaths are reported within 3 months of occurrence [5,13].

A potential limitation of our study relates to our measure of intermittent use of therapy: this was estimated based on refills and we cannot be sure that participants refilling their prescription actually took their medication. Our approach, based on incoming refills, can be judged as analogous to the community used-pill counts. However, pill counts were not measured directly. As such, our analyses probably overestimated the actual level of medication use in this population and thus underestimated its true impact on mortality. In other words, we would view this as a conservative bias. Several methods have been applied to evaluate adherence including pill count, computer-assisted electronic monitoring systems, physician assessment and patient self-report. The accuracy of these methods in estimating true levels of antiretroviral drug use remains controversial, and each has been shown to be unreliable in various settings [14,16,24].

In conclusion, our results demonstrate that intermittent use of antiretroviral therapy is associated with increased mortality. Our findings indicate that after adjusting for other important prognostic factors intermittent use of therapy was an important independent predictor of mortality in this population. Similar results were seen when AIDS-free survival was considered. These findings have important implications for long-term management of persons with HIV disease. Those individuals using antiretroviral drugs intermittently (< 75% of the time in the first year) cannot be expected to achieve the full benefits of therapy including increased duration of survival. Regardless of future advances in treatment, protracted and near perfect use of antiretroviral drugs is likely to remain a requirement of successful antiretroviral therapy.

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Acknowledgements

K. Heath is supported by a Walton Killam Memorial Pre-doctoral Fellowship, R. S. Hogg is supported by a Senior Scholar Award through the Michael Smith Foundation for Health Research and an Investigator Award through the Canadian Institutes of Health Research and D. R. Bangsberg is supported by The Doris Duke Charitable Foundation. We thank B. Devlin, D. Campbell, E. Ferris, N. Gataric, K. Hsu, M. Reginaldo and P. Vann for their research and administrative assistance.

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Morey, TE; Booth, M; Wasdo, S; Wishin, J; Quinn, B; Gonzalez, D; Derendorf, H; McGorray, SP; Simoni, J; Melker, RJ; Dennis, DM
AIDS and Behavior, 17(1): 298-306.
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AIDS and Behavior
Evaluation of the Single-Item Self-Rating Adherence Scale for Use in Routine Clinical Care of People Living with HIV
Feldman, BJ; Fredericksen, RJ; Crane, PK; Safren, SA; Mugavero, MJ; Willig, JH; Simoni, JM; Wilson, IB; Saag, MS; Kitahata, MM; Crane, HM
AIDS and Behavior, 17(1): 307-318.
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AIDS and Behavior
Masivukeni: Development of a Multimedia Based Antiretroviral Therapy Adherence Intervention for Counselors and Patients in South Africa
Remien, RH; Mellins, CA; Robbins, RN; Kelsey, R; Rowe, J; Warne, P; Chowdhury, J; Lalkhen, N; Hoppe, L; Abrams, EJ; El-Bassel, N; Witte, S; Stein, DJ
AIDS and Behavior, 17(6): 1979-1991.
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Current Hiv Research
Preclinical evaluation of a zinc finger inhibitor targeting lentivirus nucleocapsid protein in SIV-infected monkeys
Schito, ML; Soloff, AC; Slovitz, D; Trichel, A; Inman, JK; Appella, E; Turpin, JA; Barratt-Boyes, SM
Current Hiv Research, 4(3): 379-386.

International Journal of Epidemiology
Adherence to first-line antiretroviral therapy affects non-virologic outcomes among patients on treatment for more than 12 months in Lusaka, Zambia
Chi, BH; Cantrell, RA; Zulu, I; Mulenga, LB; Levy, JW; Tambatamba, BC; Reid, S; Mwango, A; Mwinga, A; Bulterys, M; Saag, MS; Stringer, JSA
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Annals of Internal Medicine
Effect of medication adherence on survival of HIV-infected adults who start highly active antiretroviral therapy when the CD4(+) cell count is 0.200 to 0.350 X 10(9) cells/L
Wood, E; Hogg, RS; Yip, B; Harrigan, PR; O'Shaughnessy, MV; Montaner, JSG
Annals of Internal Medicine, 139(): 810-816.

Journal of General Internal Medicine
Gender differences in factors associated with adherence to antiretroviral therapy
Berg, KM; Demas, PA; Howard, AA; Schoenbaum, EE; Gourevitch, MN; Arnsten, JH
Journal of General Internal Medicine, 19(): 1111-1117.

Hiv Medicine
Long-term utility of measuring adherence by self-report compared with pharmacy record in a routine clinic setting
Fairley, CK; Permana, A; Read, TRH
Hiv Medicine, 6(5): 366-369.

AIDS and Behavior
Monitoring adherence to HIV antiretroviral therapy in routine clinical practice: The past, the present, and the future
Bangsberg, DR
AIDS and Behavior, 10(3): 249-251.
10.1007/s10461-006-9121-7
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Plos One
Food Insecurity as a Barrier to Sustained Antiretroviral Therapy Adherence in Uganda
Weiser, SD; Tuller, DM; Frongillo, EA; Senkungu, J; Mukiibi, N; Bangsberg, DR
Plos One, 5(4): -.
ARTN e10340
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Janac-Journal of the Association of Nurses in AIDS Care
Antiretroviral Therapy Adherence Among Transgender Women Living With HIV
Sevelius, JM; Carrico, A; Johnson, MO
Janac-Journal of the Association of Nurses in AIDS Care, 21(3): 256-264.
10.1016/j.jana.2010.01.005
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Plos One
Not All Missed Doses Are the Same: Sustained NNRTI Treatment Interruptions Predict HIV Rebound at Low-to-Moderate Adherence Levels
Parienti, JJ; Das-Douglas, M; Massari, V; Guzman, D; Deeks, SG; Verdon, R; Bangsberg, DR
Plos One, 3(7): -.
ARTN e2783
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Indian Journal of Medical Research
Urine nevirapine as a predictor of antiretroviral adherence
Kumar, AKH; Ramachandran, G; Saradha, B; Narendran, G; Swaminathan, S
Indian Journal of Medical Research, 123(4): 565-568.

Jaids-Journal of Acquired Immune Deficiency Syndromes
What we can learn from the INSPIRE study about improving prevention and clinical care for injection drug users living with HIV
Jones, TS; Vlahov, D
Jaids-Journal of Acquired Immune Deficiency Syndromes, 46(): S31-S34.

AIDS Patient Care and Stds
The effect of mental illness, substance use, and treatment for depression on the initiation of highly active antiretroviral therapy among HIV-infected individuals
Tegger, MK; Crane, HM; Tapia, KA; Uldall, KK; Holte, SE; Kitahata, MM
AIDS Patient Care and Stds, 22(3): 233-243.
10.1089/apc.2007.0092
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Bmc Public Health
Predictors of adherence to antiretroviral therapy among HIV-infected persons: a prospective study in Southwest Ethiopia
Amberbir, A; Woldemichael, K; Getachew, S; Girma, B; Deribe, K
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ARTN 265
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Health Promotion International
The DREAM model's effectiveness in health promotion of AIDS patients in Africa
San Lio, MM; Mancinelli, S; Palombi, L; Buonomo, E; Altan, AD; Germano, P; Magid, NA; Pesaresi, A; Renzi, E; Scarcella, P; Zimba, I; Marazzi, MC
Health Promotion International, 24(1): 6-15.
10.1093/heapro/dan043
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AIDS Care-Psychological and Socio-Medical Aspects of AIDS/Hiv
Adherence to antiretroviral medication in older adults living with HIV/AIDS: a comparison of alternative models
Johnson, CJ; Heckman, TG; Hansen, NB; Kochman, A; Sikkema, KJ
AIDS Care-Psychological and Socio-Medical Aspects of AIDS/Hiv, 21(5): 541-551.
10.1080/09540120802385611
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Nature Medicine
Antiretroviral therapy to treat and prevent HIV/AIDS in resource-poor settings
Garnett, GP; Bartley, L; Grassly, NC; Anderson, RM
Nature Medicine, 8(7): 651-654.
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Journal of Infectious Diseases
Prevalence and correlates of untreated human immunodeficiency virus type 1 infection among persons who have died in the era of modern antiretroviral therapy
Wood, E; Montaner, JSG; Tyndall, MW; Schechter, MT; O'Shaughnessy, MV; Hogg, RS
Journal of Infectious Diseases, 188(8): 1164-1170.

International Journal of Std & AIDS
Pharmacy-based assessment of adherence to HAART predicts virologic and immunologic treatment response and clinical progression to AIDS and death
Kitahata, MM; Reed, SD; Dillingham, PW; Van Rompaey, SE; Young, AA; Harrington, RD; Holmes, KK
International Journal of Std & AIDS, 15(): 803-810.

Journal of Infectious Diseases
Predictors of HIV drug-resistance mutations in a large antiretroviral-naive cohort initiating triple antiretroviral therapy
Harrigan, PR; Hogg, RS; Dong, WWY; Yip, B; Wynhoven, B; Woodward, J; Brumme, CJ; Brumme, ZL; Mo, T; Alexander, CS; Montaner, JSG
Journal of Infectious Diseases, 191(3): 339-347.

Chinese Medical Journal
Highly active antiretroviral therapy per se decreased mortality and morbidity of advanced human immunodeficiency virus disease in Hong Kong
Chan, CW; Cheng, LS; Chan, WK; Wong, KH
Chinese Medical Journal, 118(): 1338-1345.

AIDS and Behavior
Self-report measures of antiretroviral therapy adherence: A review with recommendations for HIV research and clinical management
Simoni, JM; Kurth, AE; Pearson, CR; Pantalone, DW; Merrill, JO; Frick, PA
AIDS and Behavior, 10(3): 227-245.
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Jaids-Journal of Acquired Immune Deficiency Syndromes
Sustained benefit from a long-term antiretroviral adherence intervention - Results of a large randomized clinical trial
Mannheimer, SB; Morse, E; Matts, JP; Andrews, L; Child, C; Schmetter, B; Friedland, GH
Jaids-Journal of Acquired Immune Deficiency Syndromes, 43(): S41-S47.

Hiv Medicine
Superior virological response to boosted protease inhibitor-based highly active antiretroviral therapy in an observational treatment programme
Wood, E; Hogg, RS; Yip, B; Moore, D; Harrigan, PR; Montaner, JSG
Hiv Medicine, 8(2): 80-85.

Plos Medicine
A paradigm shift to prevent HIV drug resistance
Bangsberg, DR
Plos Medicine, 5(5): 695-696.
ARTN e111
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Annals of Internal Medicine
Association of Antiretroviral Therapy Adherence and Health Care Costs
Nachega, JB; Leisegang, R; Bishai, D; Nguyen, H; Hislop, M; Cleary, S; Regensberg, L; Maartens, G
Annals of Internal Medicine, 152(1): 18-W5.

Tropical Medicine & International Health
Early active follow-up of patients on antiretroviral therapy (ART) who are lost to follow-up: the 'Back-to-Care' project in Lilongwe, Malawi
Tweya, H; Gareta, D; Chagwera, F; Ben-Smith, A; Mwenyemasi, J; Chiputula, F; Boxshall, M; Weigel, R; Jahn, A; Hosseinipour, M; Phiri, S
Tropical Medicine & International Health, 15(): 82-89.
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AIDS Research and Human Retroviruses
Psychosocial Factors Affecting Medication Adherence Among HIV-1 Infected Adults Receiving Combination Antiretroviral Therapy (cART) in Botswana
Do, NT; Phiri, K; Bussmann, H; Gaolathe, T; Marlink, RG; Wester, CW
AIDS Research and Human Retroviruses, 26(6): 685-691.
10.1089/aid.2009.0222
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Jaids-Journal of Acquired Immune Deficiency Syndromes
Virologic and immunologic response, clinical progression, and highly active antiretroviral therapy adherence
Press, N; Tyndall, MW; Wood, E; Hogg, RS; Montaner, JSG
Jaids-Journal of Acquired Immune Deficiency Syndromes, 31(): S112-S117.

Clinical Infectious Diseases
Directly administered antiretroviral therapy in an urban methadone maintenance clinic: A nonrandomized comparative study
Lucas, GM; Weidle, PJ; Hader, S; Moore, RD
Clinical Infectious Diseases, 38(): S409-S413.

Antiviral Therapy
Risks of non-accidental mortality by baseline CD4(+) T-cell strata in hepatitis-C-positive and -negative individuals initiating highly active antiretroviral therapy
Moore, DM; Hogg, RS; Braitstein, P; Wood, E; Yip, B; Montaner, JSG
Antiviral Therapy, 11(1): 125-129.

Annals of Internal Medicine
Hungering for HAART
Montaner, JSG; Hogg, RS
Annals of Internal Medicine, 146(8): 609-U66.

Clinical Infectious Diseases
Optimizing treatment outcomes in HIV-infected patients with substance abuse issues
Celentano, DD; Lucas, G
Clinical Infectious Diseases, 45(): S318-S323.
10.1086/522557
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AIDS Patient Care and Stds
Prior illicit drug use and missed prenatal vitamins predict nonadherence to antiretroviral therapy in pregnancy: Adherence analysis A5084
Cohn, SE; Umbleja, T; Mrus, J; Bardeguez, AD; Andersen, JW; Chesney, MA
AIDS Patient Care and Stds, 22(1): 29-40.
10.1089/apc.2007.0053
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AIDS Patient Care and Stds
Patients' Perspectives on Informal Caregiver Involvement in HIV Health Care Appointments
Mosack, KE; Petroll, A
AIDS Patient Care and Stds, 23(): 1043-1051.
10.1089/apc.2009.0020
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Hiv Medicine
Use of a prescription-based measure of antiretroviral therapy adherence to predict viral rebound in HIV-infected individuals with viral suppression
Cambiano, V; Lampe, FC; Rodger, AJ; Smith, CJ; Geretti, AM; Lodwick, RK; Holloway, J; Johnson, M; Phillips, AN
Hiv Medicine, 11(3): 216-224.
10.1111/j.1468-1293.2009.00771.x
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Clinical Infectious Diseases
Average Adherence to Boosted Protease Inhibitor Therapy, rather than the Pattern of Missed Doses, as a Predictor of HIV RNA Replication
Parienti, JJ; Ragland, K; Lucht, F; de la Blanchardiere, A; Dargere, S; Yazdanpanah, Y; Dutheil, JJ; Perre, P; Verdon, R; Bangsberg, DR
Clinical Infectious Diseases, 50(8): 1192-1197.
10.1086/651419
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AIDS Research and Human Retroviruses
HIV VprR77Q mutation does not influence clinical response of individuals initiating highly active antiretroviral therapy
Chui, C; Cheung, PK; Brumme, CJ; Mo, T; Brumme, ZL; Montaner, JSG; Badley, AD; Harrigan, PR
AIDS Research and Human Retroviruses, 22(7): 615-618.

Hiv Medicine
CD4 percentage is an independent predictor of survival in patients starting antiretroviral therapy with absolute CD4 cell counts between 200 and 350 cells/mu L
Moore, DM; Hogg, RS; Yip, B; Craib, K; Wood, E; Montaner, JSG
Hiv Medicine, 7(6): 383-388.

Journal of the Royal Society for the Promotion of Health
A catastrophe in the 21st century: the public health situation in South Africa following HIV/AIDS
Walker, ARP; Walker, BF; Wadee, AA
Journal of the Royal Society for the Promotion of Health, 125(4): 168-171.

AIDS Patient Care and Stds
Use of electronic reminder devices to improve adherence to antiretroviral therapy: A systematic review
Wise, J; Operario, D
AIDS Patient Care and Stds, 22(6): 495-504.
10.1089/apc.2007.0180
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Hiv Medicine
British HIV Association guidelines for the treatment of HIV-1-infected adults with antiretroviral therapy 2008
Gazzard, BG
Hiv Medicine, 9(8): 563-608.
10.1111/j.1468-1293.2008.00636.x
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Tropical Medicine & International Health
Enhancing adherence to antiretroviral therapy at the HIV clinic in resource constrained countries; the Tanzanian experience
Mugusi, F; Mugusi, S; Bakari, M; Hejdemann, B; Josiah, R; Janabi, M; Aboud, S; Aris, E; Swai, H; Mhalu, F; Biberfeld, G; Pallangyo, K; Sandstrom, E
Tropical Medicine & International Health, 14(): 1226-1232.
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AIDS Reader
Seven steps to better adherence: A practical approach to promoting adherence to antiretroviral therapy
Machtinger, EL; Bangsberg, DR
AIDS Reader, 17(1): 43-50.

Cadernos De Saude Publica
Pharmacy records as an indicator of non-adherence to antiretroviral therapy by HIV-infected patients
Gomes, RRDM; Machado, CJ; Acurcio, FD; Guimaraes, MDC
Cadernos De Saude Publica, 25(3): 495-506.

Enfermedades Infecciosas Y Microbiologia Clinica
Recommendations from GESIDA/SEFH/PNS to improve adherence to antiviral treatment (2004)
Knobel, H; Escobar, I; Polo, R; Ortega, L; Martin-Conde, T; Casado, JL; Codina, C; Fernandez, J; Galindo, J; Ibarra, O; Llinas, M; Miralles, C; Riera, M; Fumaz, CR; Segador, A; Segura, Y; Chamorro, L
Enfermedades Infecciosas Y Microbiologia Clinica, 23(4): 221-231.

Clinical Infectious Diseases
Pillbox organizers are associated with improved adherence to HIV antiretroviral therapy and viral suppression: A marginal structural model analysis
Petersen, ML; Wang, Y; van der Laan, MJ; Guzman, D; Riley, E; Bangsberg, DR
Clinical Infectious Diseases, 45(7): 908-915.
10.1086/521250
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AIDS Care-Psychological and Socio-Medical Aspects of AIDS/Hiv
Treatment partners and adherence to HAART in Central Mozambique
Stubbs, BA; Micek, MA; Pfeiffer, JT; Montoya, P; Gloyd, S
AIDS Care-Psychological and Socio-Medical Aspects of AIDS/Hiv, 21(): 1412-1419.
10.1080/09540120902814395
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Clinical Therapeutics
Impact of an adherence clinic on behavioral outcomes and virologic response in the treatment of HIV infection: A prospective, randomized, controlled pilot study
Rathbun, RC; Farmer, KC; Stephens, JR; Lockhart, SM
Clinical Therapeutics, 27(2): 199-209.
10.1016/j.clinthera.2005.02.010
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AIDS
Provider bias in the selection of non-nucleoside reverse transcriptase inhibitor and protease inhibitor-based highly active antiretroviral therapy and HIV treatment outcomes in observational studies
Wood, E; Hogg, RS; Heath, KV; de la Rosa, R; Lee, N; Yip, B; O'Shaughnessy, MV; Montaner, JSG
AIDS, 17(): 2629-2634.
10.1097/01.aids.0000088224.55968.d4
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Journal of Antimicrobial Chemotherapy
Antiretroviral adherence, drug resistance, viral fitness and HIV disease progression: a tangled web is woven
Lucas, GM
Journal of Antimicrobial Chemotherapy, 55(4): 413-416.
10.1093/jac/dki042
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AIDS
No room for complacency about adherence to antiretroviral therapy in sub-Saharan Africa
Gill, CJ; Hamer, DH; Simon, JL; Thea, DA; Sabin, LL
AIDS, 19(): 1243-1249.

AIDS Care-Psychological and Socio-Medical Aspects of AIDS/Hiv
Inadequacies in antiretroviral therapy use among Aboriginal and other Canadian populations
Miller, CL; Spittal, PM; Wood, E; Chan, K; Schechter, MT; Montaner, JSG; Hogg, RS
AIDS Care-Psychological and Socio-Medical Aspects of AIDS/Hiv, 18(8): 968-976.
10.1080/09540120500481480
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Jama-Journal of the American Medical Association
Clinical outcomes and CD4 cell response in children receiving antiretroviral therapy at primary health care facilities in Zambia
Bolton-Moore, C; Mubiana-Mbewe, M; Cantrell, RA; Chintu, N; Stringer, EM; Chi, BH; Sinkala, M; Kankasa, C; Wilson, CM; Wilfert, CM; Mwango, A; Levy, J; Abrams, EJ; Bulterys, M; Stringer, JSA
Jama-Journal of the American Medical Association, 298(): 1888-1899.

Journal of Chromatography A
Screening and monitoring antiretrovirals and antivirals in the serum of acquired immunodeficiency syndrome patients by micellar liquid chromatography
Raviolo, MA; Breva, IC; Esteve-Romero, J
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10.1016/j.chroma.2009.01.082
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Enfermedades Infecciosas Y Microbiologia Clinica
How and why should adherence to antiretroviral therapy be monitored today?
Knobel, H
Enfermedades Infecciosas Y Microbiologia Clinica, 20(): 481-483.

Journal of Antimicrobial Chemotherapy
Paradoxes of adherence and drug resistance to HIV antiretroviral therapy
Bangsberg, DR; Moss, AR; Deeks, SG
Journal of Antimicrobial Chemotherapy, 53(5): 696-699.
10.1093/jac/dkh162
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AIDS
Earlier initiation of highly active antiretroviral therapy does not protect against the deleterious effects of non-adherence
Wood, E; Hogg, RS; Yip, B; Harrigan, R; Montaner, ASG
AIDS, 18(): 2432-2434.

Canadian Medical Association Journal
Effect of serostatus for hepatitis C virus on mortality among antiretrovirally naive HIV-positive patients
Braitstein, P; Yip, B; Montessori, V; Moore, D; Montaner, JSG; Hogg, RS
Canadian Medical Association Journal, 173(2): 160-164.
10.1503/cmaj.045202
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Antiviral Therapy
Modest decreases in NNRTI susceptibility do not influence virological outcome in patients receiving initial NNRTI-containing triple therapy
Harrigan, PR; Hertogs, K; Verbiest, W; Larder, B; Yip, B; Brumme, ZL; Alexander, C; Tilley, J; O'Shaughnessy, MV; Montaner, JSG
Antiviral Therapy, 8(5): 395-402.

Jaids-Journal of Acquired Immune Deficiency Syndromes
Moving from theory to research to practice - Implementing an effective dyadic intervention to improve antiretroviral adherence for clinic patients
Remien, RH; Stirratt, MJ; Dognin, J; Day, E; El-Bassel, N; Warne, P
Jaids-Journal of Acquired Immune Deficiency Syndromes, 43(): S69-S78.

Infections in Medicine
Improving adherence to antiretroviral therapy
[Anon]
Infections in Medicine, 24(1): 39.

AIDS Research and Human Retroviruses
Simple Adherence Assessments to Predict Virologic Failure among HIV-Infected Adults with Discordant Immunologic and Clinical Responses to Antiretroviral Therapy
Goldman, JD; Cantrell, RA; Mulenga, LB; Tambatamba, BC; Reid, SE; Levy, JW; Limbada, M; Taylor, A; Saag, MS; Vermund, SH; Stringer, JSA; Chi, BH
AIDS Research and Human Retroviruses, 24(8): 1031-1035.
10.1089/aid.2008.0035
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Canadian Medical Association Journal
Adherence and plasma HIV RNA responses to highly active antiretroviral therapy among HIV-1 infected injection drug users
Wood, E; Montaner, JSG; Yip, B; Tyndall, MW; Schechter, MT; O'Shaughnessy, MV; Hogg, RS
Canadian Medical Association Journal, 169(7): 656-661.

AIDS Care-Psychological and Socio-Medical Aspects of AIDS/Hiv
Adherence to combined Lamivudine plus Zidovudine versus individual components: A community-based retrospective medicaid claims analysis
Legorreta, A; Yu, A; Chernicoff, H; Gilmore, A; Jordan, J; Rosenzweig, JC
AIDS Care-Psychological and Socio-Medical Aspects of AIDS/Hiv, 17(8): 938-948.
10.1080/09540120500100692
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Clinical Infectious Diseases
Evaluating adherence to highly active antiretroviral therapy with use of pill counts and viral load measurement in the drug resources enhancement against AIDS and malnutrition program in Mozambique
Lio, MMS; Carbini, R; Germano, P; Guidotti, G; Mancinelli, S; Magid, NA; Narciso, P; Palombi, L; Renzi, E; Zimba, I; Marazzi, MC
Clinical Infectious Diseases, 46(): 1609-1616.
10.1086/587659
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Pharmacoeconomics
Cost Effectiveness of Facility-Based Care, Home-Based Care and Mobile Clinics for Provision of Antiretroviral Therapy in Uganda
Babigumira, JB; Sethi, AK; Smyth, KA; Singer, ME
Pharmacoeconomics, 27(): 963-973.

Tropical Medicine & International Health
Risk factors for treatment denial and loss to follow-up in an antiretroviral treatment cohort in Kenya
Karcher, H; Omondi, A; Odera, J; Kunz, A; Harms, G
Tropical Medicine & International Health, 12(5): 687-694.
10.1111/j.1365-3156.2007.01830.x
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Annals of Internal Medicine
Adherence to nonnucleoside reverse transcriptase inhibitor-based HIV therapy and virologic outcomes
Nachega, JB; Hislop, M; Dowdy, DW; Chaisson, RE; Regensberg, L; Maartens, G
Annals of Internal Medicine, 146(8): 564-U16.

Plos One
Interactive "Video Doctor" Counseling Reduces Drug and Sexual Risk Behaviors among HIV-Positive Patients in Diverse Outpatient Settings
Gilbert, P; Ciccarone, D; Gansky, SA; Bangsberg, DR; Clanon, K; McPhee, SJ; Calderon, SH; Bogetz, A; Gerbert, B
Plos One, 3(4): -.
ARTN e1988
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AIDS
Expanding access to HIV antiretroviral therapy among marginalized populations in the developed world
Wood, E; Montaner, JSG; Bangsberg, DR; Tyndall, MW; Strathdee, SA; O'Shaughnessy, MV; Hogg, RS
AIDS, 17(): 2419-2427.

Hiv Clinical Trials
Measuring adherence to antiretroviral therapy in a diverse population using a visual analogue scale
Giordano, TP; Guzman, D; Clark, R; Charlebois, ED; Bangsberg, DR
Hiv Clinical Trials, 5(2): 74-79.

Clinical Infectious Diseases
Less than 95% adherence to nonnucleoside reverse-transcriptase inhibitor therapy can lead to viral suppression
Bangsberg, DR
Clinical Infectious Diseases, 43(7): 939-941.

Enfermedades Infecciosas Y Microbiologia Clinica
Strategies to optimize adherence to antiretroviral treatment. Interventions in the therapeutic regimen
Knobel, H; Guelar, A
Enfermedades Infecciosas Y Microbiologia Clinica, 22(2): 106-112.

Enfermedades Infecciosas Y Microbiologia Clinica
Spanish GESIDA/Nacional AIDS plan recommendations for antiretroviral therapy in HIV-infected adults (October 2004)
Iribarren, JA; Labarga, P; Rubio, R; Berenguer, J; Miro, JM; Antela, A; Gonzalez, J; Moreno, S; Arrizabalaga, J; Chamorro, L; Clotet, B; Gatell, JM; Lopez-Aldeguer, J; Martinez, E; Polo, R; Tuset, M; Viciana, P; Santamaria, JM; Kindelan, JM; Ribera, E; Segura, F
Enfermedades Infecciosas Y Microbiologia Clinica, 22(): 564-642.

Journal of Infectious Diseases
Molecular and clinical epidemiology of CXCR4-using HIV-1 in a large population of antiretroviral-naive individuals
Brumme, ZL; Goodrich, J; Mayer, HB; Brumme, CJ; Henrick, BM; Wynhoven, B; Asselin, JJ; Cheung, PK; Hogg, RS; Montaner, JSG; Harrigan, PR
Journal of Infectious Diseases, 192(3): 466-474.

Antiviral Therapy
Initiating highly active antiretroviral therapy and continuity of HIV care: the impact of incarceration and prison release on adherence and HIV treatment outcomes
Palepu, A; Tyndall, MW; Chan, K; Wood, E; Montaner, JSG; Hogg, RS
Antiviral Therapy, 9(5): 713-719.

Drug and Alcohol Dependence
Antiretroviral adherence and HIV treatment outcomes among HIV/HCV co-infected injection drug users: The role of methadone maintenance therapy
Palepua, A; Tyndall, MW; Joy, R; Kerr, T; Wood, E; Press, N; Hogg, RS; Montaner, JSG
Drug and Alcohol Dependence, 84(2): 188-194.
10.1016/j.drugalcdep.2006.02.003
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Medical Care
Clinical and economic outcomes of nonadherence to highly active antiretroviral therapy in patients with human immunodeficiency virus
Munakata, J; Benner, JS; Becker, S; Dezii, CM; Hazard, EH; Tierce, JC
Medical Care, 44(): 893-899.

Antiviral Therapy
Adherence to antiretroviral therapy and CD4 T-cell count responses among HIV-infected injection drug users
Wood, E; Montaner, JSG; Yip, B; Tyndall, MW; Schechter, MT; O'Shaughnessy, MV; Hogg, RS
Antiviral Therapy, 9(2): 229-235.

Antiviral Therapy
Association of the CCR5 Delta 32 mutation with clinical response and > 5-year survival following initiation of first triple antiretroviral regimen
Brumme, ZL; Henrick, BM; Brumme, CJ; Hogg, RS; Montaner, JSG; Harrigan, PR
Antiviral Therapy, 10(7): 849-853.

British Medical Journal
A meta-analysis of the association between adherence to drug therapy and mortality
Simpson, SH; Eurich, DT; Majumdar, SR; Padwal, RS; Tsuyuki, RT; Varney, J; Johnson, JA
British Medical Journal, 333(): 15-18.
10.1136/bmj.38875.675486.55
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Psychotherapie Psychosomatik Medizinische Psychologie
Adherence as a result of a "Particular Relationship" - HIV-infected patients about their physician-patient relationship
Engelbach, U; Dannecker, M; Kaufhold, J; Lenz, C; Grabhorn, R
Psychotherapie Psychosomatik Medizinische Psychologie, 58(6): 253-256.
10.1055/s-2007-986320
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Atencion Farmaceutica
Combination of Direct and Indirect Methods for Measuring Hiv Patients' Adherence: Adherence-Related Factors
Morera, SD; Novoa, SR; Nacher, IJ
Atencion Farmaceutica, 10(4): 214-+.

Plos One
Antiretroviral Therapy Initiation Before, During, or After Pregnancy in HIV-1-Infected Women: Maternal Virologic, Immunologic, and Clinical Response
Melekhin, VV; Shepherd, BE; Stinnette, SE; Rebeiro, PF; Barkanic, G; Raffanti, SP; Sterling, TR
Plos One, 4(9): -.
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Keywords:

nucleoside reverse transcriptase inhibitors; protease inhibitors; non-nucleoside reverse transcriptase inhibitor; antiretroviral therapy; intermittent use of antiretrovirals; mortality; effectiveness; population based cohort

© 2002 Lippincott Williams & Wilkins, Inc.

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