Secondary Logo

Journal Logo

Institutional members access full text with Ovid®

Antiretroviral therapy adherence among treatment-naive HIV-infected patients

A retrospective cohort study

Chakraborty, Apurbaa; Qato, Dima M.b; Awadalla, Sariaa; Hershow, Ronald C.a; Dworkin, Mark S.a

doi: 10.1097/QAD.0000000000002384

Objective: To determine the incidence of antiretroviral therapy (ART) adherence among treatment-naive HIV infected patients and to evaluate the impact of single-tablet regimen (STR) on ART adherence among this population.

Design: Retrospective cohort study.

Methods: We used a nationally representative sample of IQVIA LRx Lifelink individual level pharmacy claims database during 2011–16, and defined adult patients with index date (first complete ART regimen prescription fill date) after June 30, 2011 as treatment-naive. We estimated ART adherence, measured as the proportion of days covered (PDC) during one year following the index date. We conducted multivariable analysis to identify the factors associated with optimum adherence (≥90% PDC). We also compared adherence between patients prescribed STR and multiple-tablet regimens (MTR) among those prescribed integrase strand transfer inhibitor (INSTI)- or non-nucleoside reverse transcriptase inhibitor (NNRTI)-based regimens.

Results: Overall 42.9% of the patients were optimally adherent. Adherence was significantly lower among blacks, Hispanics and patients in low income communities. Adjusting for the covariates, patients on STR had higher incidence of optimum adherence compared to those on MTR among patients on INSTI-based regimens [49% vs 24%, Relative Risk (RR), 2.16 (95% CI: 1.96–2.26)], but no significant difference was observed among those on NNRTI-based regimen [45% vs 45%, RR, 1.12 (95% CI: 0.99–1.26)].

Conclusion: Low ART adherence observed among treatment naïve patients in this nationally representative study suggests the need for public health interventions to improve adherence among this population.

aUniversity of Illinois at Chicago School of Public Health, Division of Epidemiology and Biostatistics, 1603W. Taylor Street, MC 923, Chicago, Illinois, 60612, USA

bUniversity of Illinois at Chicago College of Pharmacy, 833 S. Wood St., Chicago, Illinois, 60612, USA.

Correspondence to Apurba Chakraborty, 1603W. Taylor St. MC 923, Chicago, IL 60612. Tel: +312 375 9292; e-mail:

Received 20 April, 2019

Revised 28 August, 2019

Accepted 30 August, 2019

Supplemental digital content is available for this article. Direct URL citations appear in the printed text and are provided in the HTML and PDF versions of this article on the journal's Website (

Copyright © 2019 Wolters Kluwer Health, Inc.