Details:

Alternative Title:
J Acquir Immune Defic Syndr
Publisher's site:
http://dx.doi.org/10.1097/QAI.0000000000000084
Personal Author:
Hughes, Alison J. ; Mattson, Christine L. ; Scheer, Susan ; Beer, Linda ; Skarbinski, Jacek
Hughes, Alison J. ; Mattson, Christine L. ; Scheer, Susan ; Beer, Linda ; Skarbinski, Jacek Less -
Description:
Background

Continuous antiretroviral therapy (ART) is important for maintaining viral suppression. This analysis estimates prevalence of and reason for ART discontinuation.

Methods

Three-stage sampling was used to obtain a nationally representative, cross-sectional sample of HIV-infected adults receiving HIV care. Face-to-face interviews and medical record abstractions were collected from June 2009 to May 2010. Data were weighted based on known probabilities of selection and adjusted for nonresponse. Patient characteristics of ART discontinuation, defined as not currently taking ART, stratified by provider-initiated versus non–provider-initiated discontinuation, were examined. Weighted logistic regression models predicted factors associated with ART discontinuation.

Results

Of adults receiving HIV care in the United States who reported ever initiating ART, 5.6% discontinued treatment. Half of those who discontinued treatment reported provider-initiated discontinuation. Provider-initiated ART discontinuation patients were more likely to have a nadir CD4 ≥200 cells per cubic millimeter. Non–provider-initiated ART discontinuation patients were more likely to have unmet need for supportive services and to have not received HIV care in the past 3 months. Among all patients who discontinued, younger age, female gender, not having continuous health insurance, incarceration, injection drug use, nadir CD4 count ≥200 cells per cubic millimeter, unmet need for supportive services, no care in the past 3 months and HIV diagnosis ≥5 years before interview were independently associated with ART discontinuation.

Conclusions

These findings inform development of interventions to increase ART persistence by identifying groups at increased risk of ART discontinuation. Evidence-based interventions targeting vulnerable populations are needed and are increasingly important as recent HIV treatment guidelines have recommended universal ART.


Subject:
[+]
Adolescent
Adult
Anti-Retroviral Agents
Antiretroviral Therapy, Highly Active
Cross-Sectional Studies
Female
HIV Infections
Humans
Interviews As Topic
Male
Middle Aged
Withholding Treatment
Young Adult

Source:
J Acquir Immune Defic Syndr. 66(1):80-89.
Pubmed ID:
24326608
Pubmed Central ID:
PMC5091800
Document Type:
Journal Article
Funding:
CC999999/Intramural CDC HHS/United States
Place as Subject:
United States
Collection(s):
CDC Public Access
Main Document Checksum:
[+]
urn:sha256:b97e5a43d8abbf0eae5ab061a4096eaea1ad2fdfd92bfaae9d33042a003201e7
File Type:

Supporting Files

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