Hiv and Chronic Comorbidities: Medication Adherence and Clinical Endpoint Covariation
Topics in Antiviral Medicine
; 31(2):357, 2023.
Article
in English
| EMBASE | ID: covidwho-2317249
ABSTRACT
Background:
Evidence suggests negative monthly medication adherence trends during the COVID-19 era for patients with HIV (PWH) and multiple chronic conditions. However, it is unknown whether observed trends are associated with changes in outcomes of HIV care before and during the COVID-19 era. Method(s) Adult PWH with type 2 diabetes, hypertension, and/or hypercholesterolemia were identified in a US mid-Atlantic integrated health system. Multivariable population-averaged panel general estimating equations were used to assess the relationship between medication adherence [i.e., accepted dichotomous thresholds for optimal proportion of days covered (PDC)] for four medication groups antiretrovirals [ART], diabetes medications [DMs], renin-angiotensin antagonists [RASMs], and statins [SMs] and their related clinical endpoints [i.e., viral load (VL;copies/mL), HbA1c, systolic and diastolic blood pressure (SBP, DBP;mmHg), and total cholesterol (TC;mg/dl)] during a 37-month longitudinal observation period [9/2018-9/2021]. Covariates included demographics, number of medication groups, COVID-19 era (starting 3/1/2020), and a COVID-19/PDC interaction term. Result(s) The cohort [n=543] was predominantly 51-64y [59.30%], Black [73.11%], male [69.24%], and privately insured [65.38%]. All patients were prescribed ART with 75.32% co-prescribed SMs;followed by RASMs [42.73%];and DMs [25.60%]. ART PDC>=0.9 was associated with decreased odds of VL>=200 copies/mL [aOR=0.77, 95% CI 0.63-0.94]. For DMs, RASMs and SMS, PDC>=0.8 was not associated with the clinical endpoints of HbA1c>=7.0% [aOR=0.99, 95% CI 0.94-1.04], SBP>=130 mmHg [aOR=1.03;95% CI 0.93-1.14], DBP>=80 mmHg [aOR=1.05, 95% CI 0.94-1.16] or TC>=200 mg/dl [aOR=1.00, 95% CI 0.96-1.04], respectively. The COVID-19 era [3/2020 to 9/2021] was associated with increased odds of SBP>=130 [aOR=1.22, 95% CI 1.01-1.48], but not for DBP>=80 mmHg [aOR=1.05, 95% CI 0.85-1.28], VL>=200 copies/ mL [aOR=1.01, 95% CI 0.67-1.52], HbA1c>=7.0% [aOR=0.99, 95% CI 0.88-1.11], and TC>=200 mg/dl [aOR=0.95, 95% CI 0.86-1.04]. No interactions between COVID-19 era and PDC on clinical endpoints were observed. Conclusion(s) ART adherence was associated with viral suppression in PWH, but there were no observed associations between DM, RASM, and SM adherence and their respective clinical endpoints. With the exception of a direct relationship between the COVID-19 start date and SBP, the COVID-19 era was not associated with variations in VL, HbA1c, DBP, and TC clinical endpoints.
adult; antiretroviral therapy; cholesterol blood level; cohort analysis; conference abstract; controlled study; coronavirus disease 2019; demographics; diabetes mellitus; diastolic blood pressure; female; human; Human immunodeficiency virus 2; hypercholesterolemia; hypertension; major clinical study; male; medication compliance; non insulin dependent diabetes mellitus; nonhuman; systolic blood pressure; virus load; angiotensin antagonist; endogenous compound; hemoglobin A1c; hydroxymethylglutaryl coenzyme A reductase inhibitor; renin
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Collection:
Databases of international organizations
Database:
EMBASE
Type of study:
Prognostic study
Language:
English
Journal:
Topics in Antiviral Medicine
Year:
2023
Document Type:
Article
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