Study explores adherence trajectories, virologic failure, and interventions in US women with HIV

Medication adherence remains a challenge for many women with HIV in the US, in particular those experiencing depression or consuming a high amount of alcohol, according to recently published findings. Classifying participants by trajectories, rather than dichotomies, could identify factors that encourage better adherence, the study authors suggest.

About This Study

“Trajectories of Antiretroviral Therapy Adherence and Virologic Failure in Women with HIV in the United States” was published online on Feb. 20, 2023, in Journal of Acquired Immune Deficiency Syndromes. The lead author is Abubaker Ibrahim Elbur, Ph.D., from the Center for Global Health at Massachusetts General Hospital.

Key Research Findings

This study’s goal was to determine the association between ART adherence trajectories and the risk of virologic failure in women with HIV.

The 1,437 participants who met the inclusion criteria were from the US Women’s Interagency HIV Study, enrolled from 2014-2019. Most participants (74%) identified as African American and 78% had been diagnosed with HIV for at least 20 years. In this sample, 12% experienced virological failure over the median follow-up time of 54 months.

Among women with virological failure, 34% percent of participants were considered to have “consistently low,” 31% “moderately decreasing,” 10% “moderately increasing,” and 26% “consistently high” adherence to their treatment. Women in the “consistently low” category experienced more depression and consumed more alcohol than participants in the other categories.

The overall rate of detectable viremia was lower than in a study conducted between 2006-2011, the study authors noted; they stated this was likely due to better tolerated modern antiretrovirals, as well as 2012 guideline changes that recommended treatment for everyone, regardless of CD4+ cell count.

Women in the two lower adherence categories (“moderately decreasing” and “consistently low”) were more likely to experience virological failure than those in the two higher categories. Participants in the two middle categories (“moderately decreasing” and “moderately increasing”) started at similar baseline adherence levels, but diverged after a year.

Discussion Highlights and Implications for Practice

The researchers recommended that additional qualitative studies be undertaken to understand why the two middle groups (“moderately decreasing” and “moderately increasing”) diverged, and to learn what could be done to encourage adherence.

The authors also pointed out that one study limitation was the self-reported nature of ART adherence. Five percent of women in the highest adherence category experienced virological failure–which could indicate misreported adherence but could also be due to drug resistance to their current regimen.

Additional recommendations offered by the study authors for improving treatment adherence among WLWH included:

• Interventions should focus on women in the “consistently low” and “moderately decreasing” categories.
• Heavy alcohol consumption needs to be addressed both to improve overall health and to help women take medications as prescribed.
• Cognitive behavioral therapy could improve both depressive symptoms and medication adherence.

By Barbara Jungwirth