Sociodemographic factors predict early discontinuation of HIV non-nucleoside reverse transcriptase inhibitors and protease inhibitors

Abstract

Background/objective: HIV infection has a devastating impact on individual and public health, and affects populations disproportionately. Treatment with antiretroviral therapy (ART) saves lives, but long-term adherence to ART is critical to its success. We performed an observational cohort study to determine the influence of race, sex and other sociodemographic factors on early ART discontinuations among HIV-infected persons.

Methods: TennCare-enrolled adults of black or white non-Hispanic race beginning ART with either a non-nucleoside reverse transcriptase inhibitor (NNRTI) or protease inhibitor (PI) between 1996-2003 (N=3654) were assessed for early discontinuation. A subgroup of discontinuations was validated using the primary medical record.

Results: Blacks were more likely than whites to discontinue NNRTIs (37 vs. 28%; P=0.003) and PIs (36 vs. 25%; P < or = 0.001). In multivariable models adjusting for race, sex, age, early HIV-related medical encounter, urban residence and TennCare enrollment category, black race, female sex and younger age were independent predictors of discontinuation among those starting PIs. Among persons starting NNRTIs, black race, younger age and a disability-based enrollment category predicted early drug discontinuation, but female sex did not.

Conclusions: Our results suggest that sociodemographic factors were associated with early NNRTI and PI discontinuation in this population, and some factors were ART class specific.

Figure 1. Schematic representation of study definitions for qualifying drug initiation and discontinuation using the TennCare pharmacy data file

To qualify for the overall study cohort, an individual was required to have been non-Hispanic white or black and have ≥1 additional prescription medication refill (of any type) and/or 1 HIV-related medical encounter during the first 90 days after entry. Entry date could have been from January 1, 1996 to June 30, 2003. Schema A represents a nondiscontinuer; Schema B represents an individual defined as an early discontinuer, including the subgroup included in the validation analysis. ART: Antiretroviral therapy; PI: Protease inhibitor; NNRTI: Non-nucleoside reverse transcriptase inhibitor

Figure 2. Flow diagram of disposition of individuals included in the overall TennCare cohort and validation analyses

CCC: Comprehensive care center; PI: Protease inhibitor; NNRTI: Non-nucleoside reverse transcriptase inhibitor