Factors and Temporal Trends Associated With Highly Active Antiretroviral Therapy Discontinuation in the Women's Interagency HIV Study

We characterized factors and temporal trends associated with discontinuation of highly active antiretroviral therapy (HAART) among 936 HIV-infected women enrolled in the Women's Interagency HIV Study. A multivariate analysis of post-HAART initiation exposures found that high HIV RNA levels (relative hazard [RH] = 1.36, P < 0.001) and high depressive symptom scores (RH = 1.53, P = 0.012) were associated with HAART discontinuation. The adjusted hazard of discontinuation was higher in the 2 most recent calendar periods compared with the first (RH = 1.61, P = 0.026; RH = 1.56, P = 0.074, respectively). The increasing risk of HAART discontinuation in recent calendar periods and changes in the clinical factors associated with discontinuation reflect ongoing and dynamic shifts in the approach to HAART utilization.

[1]  R. Greenblatt,et al.  Effectiveness of highly active antiretroviral therapy among HIV-1 infected women , 2002, Journal of epidemiology and community health.

[2]  M. Chesney,et al.  Patient- and provider-reported adherence: toward a clinically useful approach to measuring antiretroviral adherence. , 2001, Journal of clinical epidemiology.

[3]  Mardge H. Cohen,et al.  Discontinuation of potent antiretroviral therapy: predictive value of and impact on CD4 cell counts and HIV RNA levels , 2001, AIDS.

[4]  A Muñoz,et al.  Methods to assess population effectiveness of therapies in human immunodeficiency virus incident and prevalent cohorts. , 2001, American journal of epidemiology.

[5]  V. Vullo,et al.  Time to discontinuation of the first highly active antiretroviral therapy regimen: a comparison between protease inhibitor- and non-nucleoside reverse transcriptase inhibitor-containing regimens. , 2001, AIDS.

[6]  C. Sabin,et al.  Reasons for modification and discontinuation of antiretrovirals: results from a single treatment centre , 2001, AIDS.

[7]  J. Phair,et al.  Determinants of Heterogeneous Adherence to HIV‐Antiretroviral Therapies in the Multicenter AIDS Cohort Study , 2001, Journal of acquired immune deficiency syndromes.

[8]  M. Moroni,et al.  Insights into the reasons for discontinuation of the first highly active antiretroviral therapy (HAART) regimen in a cohort of antiretroviral naïve patients , 2000, AIDS.

[9]  M A Fischl,et al.  Antiretroviral Therapy in Adults Updated Recommendations of the International AIDS Society–USA Panel , 2000 .

[10]  A Muñoz,et al.  Effectiveness of potent antiretroviral therapy on time to AIDS and death in men with known HIV infection duration. Multicenter AIDS Cohort Study Investigators. , 1998, JAMA.

[11]  D. Cotton.  Do we still need a cohort study of women with HIV infection? , 1998, Epidemiology.

[12]  Joseph Feldman,et al.  The Women's Interagency HIV Study , 1998 .

[13]  M A Fischl,et al.  A controlled trial of two nucleoside analogues plus indinavir in persons with human immunodeficiency virus infection and CD4 cell counts of 200 per cubic millimeter or less. AIDS Clinical Trials Group 320 Study Team. , 1997, The New England journal of medicine.

[14]  B Wise,et al.  Antiretroviral therapy in adults. , 1996, Journal of the American Academy of Nurse Practitioners.

[15]  Bradley Efron,et al.  The Effect of High-Dose Saquinavir on Viral Load and CD4+ T-Cell Counts in HIV-Infected Patients , 1996, Annals of Internal Medicine.

[16]  A. Wu,et al.  Derivation and properties of a brief health status assessment instrument for use in HIV disease. , 1995, Journal of acquired immune deficiency syndromes and human retrovirology : official publication of the International Retrovirology Association.