The influence of patient beliefs and treatment satisfaction on the discontinuation of current first‐line antiretroviral regimens

• Published in: HIV medicine Vol. 17; no. 1; pp. 46 - 55
• Main Authors: Casado, JL, Marín, A, Romero, V, Bañón, S, Moreno, A, Perez‐Elías, MJ, Moreno, S, Rodriguez‐Sagrado, MA
• Format: Journal Article
• Language: English
• Published: England 01.01.2016
• Subjects: Adult; Anti-HIV Agents - adverse effects; Anti-HIV Agents - therapeutic use; antiretroviral durability; Antiretroviral Therapy, Highly Active - adverse effects; Benzoxazines - adverse effects; Benzoxazines - therapeutic use; Cohort Studies; Female; HIV; HIV Infections - drug therapy; HIV Infections - psychology; Human immunodeficiency virus; Humans; Male; Middle Aged; patient beliefs; Patient Satisfaction - statistics & numerical data; Personal Satisfaction; Proportional Hazards Models; psychosocial; satisfaction; Treatment Outcome; psychosocial; patient beliefs; HIV; antiretroviral durability; satisfaction
• ISSN: 1464-2662; 1468-1293
• DOI: 10.1111/hiv.12280

Objectives Large cohort studies have shown a high rate of first‐line combination antiretroviral therapy (cART) regimen discontinuation in HIV‐infected patients, attributed to characteristics of the cART regimen or toxicity. Methods A cohort study of 274 patients receiving a first‐line regimen was carried out. Patients' perceptions and beliefs prior to initiation were assessed using an attitude towards medication scale (0−15 points), and their satisfaction during therapy was assessed using an HIV treatment satisfaction questionnaire (HIVTSQ). Treatment discontinuation was defined as any switch in the cART regimen. Results During 474.8 person‐years of follow‐up, 63 (23%) patients changed their cART regimen, mainly because of toxicity/intolerance (42; 67%). The overall rate of change was 13.2 per 100 patient‐years [95% confidence interval (CI) 11.1–16.4 per 100 patient‐years]. An efavirenz (EFV)‐based single tablet regimen showed the highest rate of adverse events (27%), but the lowest rate of change (16%; 7.44 per 100 patient‐years). Cox regression revealed a decreased hazard of first regimen termination with better initial attitude towards drugs [hazard ratio (HR) 0.76; 95% CI 0.62–0.93; P < 0.01] and higher satisfaction (HR 0.94; 95% CI 0.89–0.99; P = 0.01), and an increased hazard of termination with the presence of adverse events (HR 7.7; 95% CI 2.4–11.6; P < 0.01). One‐third of patients (18 of 59; 31%) with mild/moderate adverse events (which were mainly central nervous system symptoms) continued the regimen; these patients, compared with those discontinuing therapy, showed better perception of therapy (mean score 14.4 versus 12.1, respectively; P = 0.05) and greater satisfaction during therapy (mean score 50.6 versus 44.6, respectively; P = 0.04). Conclusions Patients' beliefs and satisfaction with therapy influence the durability of the first antiretroviral regimen. These patient‐related factors modulate the impact of mild adverse events, and could explain differences in the rate of discontinuation.