Comparing Adherence to Two Different HIV Antiretroviral Regimens: An Instrumental Variable Analysis
The objective of this observational cohort study was to compare adherence to protease inhibitor (PI)-based regimens or non-nucleoside reverse transcriptase inhibitor (NNRTI)-based regimens. HIV-seropositive, antiretroviral-naïve patients initiating therapy between 1998 and 2006 were identified using...
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| Veröffentlicht in: | AIDS and behavior 2013, Vol.17 (1), p.160-167 |
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| creator | Nelson, Richard E. Nebeker, Jonathan R. Hayden, Candace Reimer, Larry Kone, Karen LaFleur, Joanne |
| description | The objective of this observational cohort study was to compare adherence to protease inhibitor (PI)-based regimens or non-nucleoside reverse transcriptase inhibitor (NNRTI)-based regimens. HIV-seropositive, antiretroviral-naïve patients initiating therapy between 1998 and 2006 were identified using Veterans Health Administration databases. First-year adherence ratios were calculated as proportion of days covered (PDC). Multivariable regressions were run with an indicator for PDC >95, 90, 85, and 80 % as the dependent variable and an indicator for a PI-based regimen as the key independent variable. We controlled for residual unmeasured confounding by indication using an instrumental variable technique, using the physician’s prescribing preference as the instrument. Out of 929 veterans on PI-based and 747 on NNRTI-based regimens, only 19.7 % of PI patients had PDC >80 %, compared to 35.1 % of NNRTI patients. In multivariable analysis, starting a PI regimen was significantly associated with poor adherence for all 4 adherence thresholds using conventional regressions and instrumental variable methods. |
| doi_str_mv | 10.1007/s10461-012-0266-2 |
| format | Article |
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HIV-seropositive, antiretroviral-naïve patients initiating therapy between 1998 and 2006 were identified using Veterans Health Administration databases. First-year adherence ratios were calculated as proportion of days covered (PDC). Multivariable regressions were run with an indicator for PDC >95, 90, 85, and 80 % as the dependent variable and an indicator for a PI-based regimen as the key independent variable. We controlled for residual unmeasured confounding by indication using an instrumental variable technique, using the physician’s prescribing preference as the instrument. Out of 929 veterans on PI-based and 747 on NNRTI-based regimens, only 19.7 % of PI patients had PDC >80 %, compared to 35.1 % of NNRTI patients. In multivariable analysis, starting a PI regimen was significantly associated with poor adherence for all 4 adherence thresholds using conventional regressions and instrumental variable methods.</description><identifier>ISSN: 1090-7165</identifier><identifier>EISSN: 1573-3254</identifier><identifier>DOI: 10.1007/s10461-012-0266-2</identifier><identifier>PMID: 22869102</identifier><identifier>CODEN: AIBEFC</identifier><language>eng</language><publisher>Boston: Springer US</publisher><subject>Acquired Immune Deficiency Syndrome ; Adult ; AIDS ; Anti-HIV Agents - administration & dosage ; Antiretroviral agents ; Antiretroviral Therapy, Highly Active ; Antiviral agents ; CD4 Lymphocyte Count ; Drug Administration Schedule ; Drug therapy ; Female ; Follow-Up Studies ; Health ; Health Psychology ; HIV ; HIV Infections - drug therapy ; HIV Protease Inhibitors - administration & dosage ; HIV Protease Inhibitors - therapeutic use ; Hospital administration ; Human immunodeficiency virus ; Humans ; Infectious Diseases ; Male ; Medication Adherence ; Medications ; Medicine ; Medicine & Public Health ; Middle Aged ; Multivariate Analysis ; Observational studies ; Original Paper ; Patients ; Physicians ; Proteinase inhibitors ; Public Health ; Registries ; Regression Analysis ; Reverse Transcriptase Inhibitors - administration & dosage ; Reverse Transcriptase Inhibitors - therapeutic use ; Risk Factors ; United States ; United States Department of Veterans Affairs ; Veterans ; Viral Load</subject><ispartof>AIDS and behavior, 2013, Vol.17 (1), p.160-167</ispartof><rights>Springer Science+Business Media, LLC 2012</rights><rights>Springer Science+Business Media New York 2013</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c438t-e9c10bfeae457c3063b5023e290794b2b75b667cf9d1b5e878e6078124c5d163</citedby><cites>FETCH-LOGICAL-c438t-e9c10bfeae457c3063b5023e290794b2b75b667cf9d1b5e878e6078124c5d163</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://link.springer.com/content/pdf/10.1007/s10461-012-0266-2$$EPDF$$P50$$Gspringer$$H</linktopdf><linktohtml>$$Uhttps://link.springer.com/10.1007/s10461-012-0266-2$$EHTML$$P50$$Gspringer$$H</linktohtml><link.rule.ids>314,780,784,27344,27924,27925,33774,33775,41488,42557,51319</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/22869102$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Nelson, Richard E.</creatorcontrib><creatorcontrib>Nebeker, Jonathan R.</creatorcontrib><creatorcontrib>Hayden, Candace</creatorcontrib><creatorcontrib>Reimer, Larry</creatorcontrib><creatorcontrib>Kone, Karen</creatorcontrib><creatorcontrib>LaFleur, Joanne</creatorcontrib><title>Comparing Adherence to Two Different HIV Antiretroviral Regimens: An Instrumental Variable Analysis</title><title>AIDS and behavior</title><addtitle>AIDS Behav</addtitle><addtitle>AIDS Behav</addtitle><description>The objective of this observational cohort study was to compare adherence to protease inhibitor (PI)-based regimens or non-nucleoside reverse transcriptase inhibitor (NNRTI)-based regimens. HIV-seropositive, antiretroviral-naïve patients initiating therapy between 1998 and 2006 were identified using Veterans Health Administration databases. First-year adherence ratios were calculated as proportion of days covered (PDC). Multivariable regressions were run with an indicator for PDC >95, 90, 85, and 80 % as the dependent variable and an indicator for a PI-based regimen as the key independent variable. We controlled for residual unmeasured confounding by indication using an instrumental variable technique, using the physician’s prescribing preference as the instrument. Out of 929 veterans on PI-based and 747 on NNRTI-based regimens, only 19.7 % of PI patients had PDC >80 %, compared to 35.1 % of NNRTI patients. In multivariable analysis, starting a PI regimen was significantly associated with poor adherence for all 4 adherence thresholds using conventional regressions and instrumental variable methods.</description><subject>Acquired Immune Deficiency Syndrome</subject><subject>Adult</subject><subject>AIDS</subject><subject>Anti-HIV Agents - administration & dosage</subject><subject>Antiretroviral agents</subject><subject>Antiretroviral Therapy, Highly Active</subject><subject>Antiviral agents</subject><subject>CD4 Lymphocyte Count</subject><subject>Drug Administration Schedule</subject><subject>Drug therapy</subject><subject>Female</subject><subject>Follow-Up Studies</subject><subject>Health</subject><subject>Health Psychology</subject><subject>HIV</subject><subject>HIV Infections - drug therapy</subject><subject>HIV Protease Inhibitors - administration & dosage</subject><subject>HIV Protease Inhibitors - therapeutic use</subject><subject>Hospital administration</subject><subject>Human immunodeficiency virus</subject><subject>Humans</subject><subject>Infectious Diseases</subject><subject>Male</subject><subject>Medication Adherence</subject><subject>Medications</subject><subject>Medicine</subject><subject>Medicine & Public Health</subject><subject>Middle Aged</subject><subject>Multivariate Analysis</subject><subject>Observational studies</subject><subject>Original Paper</subject><subject>Patients</subject><subject>Physicians</subject><subject>Proteinase inhibitors</subject><subject>Public Health</subject><subject>Registries</subject><subject>Regression Analysis</subject><subject>Reverse Transcriptase Inhibitors - administration & dosage</subject><subject>Reverse Transcriptase Inhibitors - therapeutic use</subject><subject>Risk Factors</subject><subject>United States</subject><subject>United States Department of Veterans Affairs</subject><subject>Veterans</subject><subject>Viral Load</subject><issn>1090-7165</issn><issn>1573-3254</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2013</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><sourceid>8G5</sourceid><sourceid>ABUWG</sourceid><sourceid>AFKRA</sourceid><sourceid>AZQEC</sourceid><sourceid>BENPR</sourceid><sourceid>BHHNA</sourceid><sourceid>CCPQU</sourceid><sourceid>DWQXO</sourceid><sourceid>GNUQQ</sourceid><sourceid>GUQSH</sourceid><sourceid>M2O</sourceid><recordid>eNqNkUtrFEEURgsxmBj9AW6kwY2bNvfWu9wNYzQDAUGGbIvumtuxQz_Gqu5I_r3VmSgihLiqx3fuV1CHsTcIHxDAnCUEqbEE5CVwrUv-jJ2gMqIUXMnneQ8OSoNaHbOXKd0AgNPGvWDHnFvtEPgJC-ux31exHa6L1e47RRoCFdNYbH-Oxae2aZabqbjYXBWrYWojTXG8bWPVFd_ouu1pSB9zUGyGNMU5H6ecXOW6qu4oB1V3l9r0ih01VZfo9cN6yrafz7fri_Ly65fNenVZBinsVJILCHVDFUllggAtagVcEHdgnKx5bVSttQmN22GtyBpLGoxFLoPaoRan7P2hdh_HHzOlyfdtCtR11UDjnDxKaZ1zAOpplDvUKKz9j1ZuhFYShcvou3_Qm3GO-RPuKbTWSblQeKBCHFOK1Ph9bPsq3nkEv2j1B60-a_WLVs_zzNuH5rnuafdn4rfHDPADkPaLS4p_Pf1o6y99Eqra</recordid><startdate>2013</startdate><enddate>2013</enddate><creator>Nelson, Richard E.</creator><creator>Nebeker, Jonathan R.</creator><creator>Hayden, Candace</creator><creator>Reimer, Larry</creator><creator>Kone, Karen</creator><creator>LaFleur, Joanne</creator><general>Springer US</general><general>Springer Nature B.V</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>0-V</scope><scope>3V.</scope><scope>7RV</scope><scope>7T2</scope><scope>7U3</scope><scope>7U9</scope><scope>7X7</scope><scope>7XB</scope><scope>88E</scope><scope>88G</scope><scope>8AM</scope><scope>8AO</scope><scope>8C1</scope><scope>8FI</scope><scope>8FJ</scope><scope>8FK</scope><scope>8G5</scope><scope>ABUWG</scope><scope>AEUYN</scope><scope>AFKRA</scope><scope>ALSLI</scope><scope>AZQEC</scope><scope>BENPR</scope><scope>BGRYB</scope><scope>BHHNA</scope><scope>C1K</scope><scope>CCPQU</scope><scope>DWQXO</scope><scope>FYUFA</scope><scope>GHDGH</scope><scope>GNUQQ</scope><scope>GUQSH</scope><scope>H94</scope><scope>HEHIP</scope><scope>K7.</scope><scope>K9.</scope><scope>KB0</scope><scope>M0O</scope><scope>M0S</scope><scope>M1P</scope><scope>M2M</scope><scope>M2O</scope><scope>M2S</scope><scope>MBDVC</scope><scope>NAPCQ</scope><scope>PQEST</scope><scope>PQQKQ</scope><scope>PQUKI</scope><scope>PSYQQ</scope><scope>Q9U</scope><scope>7X8</scope></search><sort><creationdate>2013</creationdate><title>Comparing Adherence to Two Different HIV Antiretroviral Regimens: An Instrumental Variable Analysis</title><author>Nelson, Richard E. ; Nebeker, Jonathan R. ; Hayden, Candace ; Reimer, Larry ; Kone, Karen ; LaFleur, Joanne</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c438t-e9c10bfeae457c3063b5023e290794b2b75b667cf9d1b5e878e6078124c5d163</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2013</creationdate><topic>Acquired Immune Deficiency Syndrome</topic><topic>Adult</topic><topic>AIDS</topic><topic>Anti-HIV Agents - 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Academic</collection><jtitle>AIDS and behavior</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Nelson, Richard E.</au><au>Nebeker, Jonathan R.</au><au>Hayden, Candace</au><au>Reimer, Larry</au><au>Kone, Karen</au><au>LaFleur, Joanne</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Comparing Adherence to Two Different HIV Antiretroviral Regimens: An Instrumental Variable Analysis</atitle><jtitle>AIDS and behavior</jtitle><stitle>AIDS Behav</stitle><addtitle>AIDS Behav</addtitle><date>2013</date><risdate>2013</risdate><volume>17</volume><issue>1</issue><spage>160</spage><epage>167</epage><pages>160-167</pages><issn>1090-7165</issn><eissn>1573-3254</eissn><coden>AIBEFC</coden><abstract>The objective of this observational cohort study was to compare adherence to protease inhibitor (PI)-based regimens or non-nucleoside reverse transcriptase inhibitor (NNRTI)-based regimens. HIV-seropositive, antiretroviral-naïve patients initiating therapy between 1998 and 2006 were identified using Veterans Health Administration databases. First-year adherence ratios were calculated as proportion of days covered (PDC). Multivariable regressions were run with an indicator for PDC >95, 90, 85, and 80 % as the dependent variable and an indicator for a PI-based regimen as the key independent variable. We controlled for residual unmeasured confounding by indication using an instrumental variable technique, using the physician’s prescribing preference as the instrument. Out of 929 veterans on PI-based and 747 on NNRTI-based regimens, only 19.7 % of PI patients had PDC >80 %, compared to 35.1 % of NNRTI patients. In multivariable analysis, starting a PI regimen was significantly associated with poor adherence for all 4 adherence thresholds using conventional regressions and instrumental variable methods.</abstract><cop>Boston</cop><pub>Springer US</pub><pmid>22869102</pmid><doi>10.1007/s10461-012-0266-2</doi><tpages>8</tpages></addata></record> |
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| subjects | Acquired Immune Deficiency Syndrome Adult AIDS Anti-HIV Agents - administration & dosage Antiretroviral agents Antiretroviral Therapy, Highly Active Antiviral agents CD4 Lymphocyte Count Drug Administration Schedule Drug therapy Female Follow-Up Studies Health Health Psychology HIV HIV Infections - drug therapy HIV Protease Inhibitors - administration & dosage HIV Protease Inhibitors - therapeutic use Hospital administration Human immunodeficiency virus Humans Infectious Diseases Male Medication Adherence Medications Medicine Medicine & Public Health Middle Aged Multivariate Analysis Observational studies Original Paper Patients Physicians Proteinase inhibitors Public Health Registries Regression Analysis Reverse Transcriptase Inhibitors - administration & dosage Reverse Transcriptase Inhibitors - therapeutic use Risk Factors United States United States Department of Veterans Affairs Veterans Viral Load |
| title | Comparing Adherence to Two Different HIV Antiretroviral Regimens: An Instrumental Variable Analysis |
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