The impact of specific HIV treatment-related adverse events on adherence to antiretroviral therapy: A systematic review and meta-analysis

• Published in: AIDS care Vol. 25; no. 4; pp. 400 - 414
• Main Authors: Al-Dakkak, Imad, Patel, Seema, McCann, Eilish, Gadkari, Abhijit, Prajapati, Girish, Maiese, Eric M.
• Format: Journal Article
• Language: English
• Published: Abingdon Taylor & Francis Group 01-04-2013; Taylor & Francis; Taylor & Francis Ltd
• Subjects: Acquired immune deficiency syndrome; Adherence; Adolescent; Adult; adverse events; AIDS; Anti-HIV Agents - administration & dosage; Anti-HIV Agents - adverse effects; Antiretroviral drugs; Antiretroviral therapy; Biological and medical sciences; CD4 Lymphocyte Count; Confusion - chemically induced; Critical incidents; Disease Progression; Drug Administration Schedule; Drug Resistance, Viral; Drug toxicity and drugs side effects treatment; Fatigue - chemically induced; Female; Health care; HIV; HIV Infections - complications; HIV Infections - drug therapy; HIV Infections - immunology; Human immunodeficiency virus; Human viral diseases; Humans; Immunodeficiencies; Immunodeficiencies. Immunoglobulinopathies; Immunopathology; Infectious diseases; Male; Medical sciences; Medical treatment; Medication Adherence - psychology; Medication Adherence - statistics & numerical data; Meta-analysis; Miscellaneous (drug allergy, mutagens, teratogens...); Nausea - chemically induced; Noncompliance; Patient Education as Topic; Patients; Pharmacology. Drug treatments; Random effects; Risk; Risk factors; Systematic review; Taste Disorders - chemically induced; Viral diseases; Viral diseases of the lymphoid tissue and the blood. Aids; United Kingdom; Europe; Social environment; Antiretroviral agent; Toxicity; antiretroviral therapy; Mental health; Pharmacotherapy; Review; Metaanalysis; Drug compliance; Antiviral; Complication; Public health; Human; Immunopathology; adherence; Retroviridae; AIDS; adverse events; Immune deficiency; Lentivirus; Infection; Virus; Treatment; HIV; Viral disease; Human immunodeficiency virus
• ISSN: 0954-0121; 1360-0451
• DOI: 10.1080/09540121.2012.712667

Poor adherence to antiretroviral therapies (ARTs) in human immunodeficiency virus (HIV)-infected patients increases the risk of incomplete viral suppression, development of viral resistance, progression to acquired immune deficiency syndrome and death. This study assesses the impact of specific treatment-related adverse events (AEs) on adherence to ART in the adult HIV patient population. A systematic review of studies involving adult HIV-infected patients aged ≥ 16 years that reported an odds ratio (OR) for factors affecting adherence to ART was conducted through a search of the EMBASE® and Medline® databases. Database searches were complemented with a search of titles in the bibliographies of review papers. Studies conducted in populations limited to a particular demographic characteristic or behavioural risk were excluded. To qualify for inclusion into a meta-analysis, treatment-related AEs had to be defined similarly across studies. Also, multiple ORs from the same study were included where study sub-groups were distinct. Random effects models were used to pool ORs. In total, 19 studies and 18 ART-related AEs were included in meta-analyses. Adherence to ART was significantly lower in patients with non-specific AEs than in patients who did not experience AEs [OR = 0.623; 95% confidence interval (CI): 0.465-0.834]. Patients with specific AEs such as fatigue (OR = 0.631; 95% CI: 0.433-0.918), confusion (OR = 0.349; 95% CI: 0.184-0.661), taste disturbances (OR = 0.485; 95% CI: 0.303-0.775) and nausea (OR = 0.574; 95% CI: 0.427-0.772) were significantly less likely to adhere to ART compared to patients without these AEs. Knowledge of specific treatment-related AEs may allow for targeted management of these events and a careful consideration of well-tolerated treatment regimens to improve ART adherence and clinical outcomes.