A recent study of Medicaid data in the US has found that HIV patients are adhering better to their disease management medications, compared to previous years. The study – conducted by researchers at Brown University and published in the journal, AIDS – found that persistence with HIV antiretroviral therapy increased by 50 percent between 2001 and 2010.
“This represents a lot of people who are not dying and not infecting others,” said corresponding author Dr. Ira Wilson, chair of the Health Services Policy and Practice department in the Brown University School of Public Health. “These differences represent tremendous, very real benefit.”
The availability of modern antiretroviral drugs means that HIV is now a more manageable condition that it used to be, and people with the chronic infection are living longer than ever before. In 1996, the life expectancy of an HIV-positive person was just 39 years; this number jumped to 73 years in 2011.
Wilson and his colleagues used Medicaid claims data to study how long over 43,000 HIV-positive patients continued taking their antiretroviral therapy. In order to establish a frame of reference for their analysis, the researchers compared the medication adherence data to that collected on hundreds of thousands of HIV-negative patients for other chronic medications, such as statins for high cholesterol and metformin for type II diabetes.
Between 2001 and 2003, 50 percent of patients ceased their antiretroviral therapy for HIV about two years after starting the medication. By 2004 to 2006, this medication adherence figure had increased to just over 35 months.
In the later third of the study period, from 2007 to 2010, median medication persistence reached 50 percent. After taking into account confounding factors, the researchers concluded that this last cohort of patients were at a lesser risk of stopping their medication, compared to patients at the start of the study period.
While the trend towards increased HIV medication adherence is certainly promising, the researchers say that this number could still be improved. In particular, their analysis found that women, African Americans and those living in select states – including Louisiana and Texas – were at a higher risk of prematurely discontinuing their antiretroviral therapy.
Despite the myriad benefits of antiretroviral therapy – including life extension and reduced risk of HIV transmission – multiple factors still contribute to a patient’s decision to stop taking the medications. Among these factors are the cost of medication, potential side effects and the persistent stigma surrounding an HIV diagnosis.
“Although it is improving, it is still not optimal,” said primary author Bora Youn, a graduate student in Wilson’s group. “There is lots of room for further improvement. Still many people discontinue therapy in a short period of time.”