Skip to main content
SpringerLink
Log in

Aging, Antiretrovirals, and Adherence: A Meta Analysis of Adherence among Older HIV-Infected Individuals

  • Systematic Review
  • Published:
Drugs & Aging Aims and scope Submit manuscript

Abstract

Introduction

Older adults are generally considered to be at greater risk for medication non-adherence due to factors such as medication complexity, side effects, cost, and cognitive decline. However, this generalization may not apply to older adults with human immunodeficiency virus (HIV). Regardless of age, suboptimal adherence to antiretroviral therapy (ART) can lead to increased viral load, immunosuppression, drug-resistant viral strains, co-morbidities, and opportunistic infections. Understanding trends of adherence to ART among older adults is critical, especially as the population of people living with HIV grows older.

Objectives

The purpose of this systematic review and meta-analysis is to determine if older individuals with HIV are less likely to be non-adherent to antiretroviral therapy than younger individuals with HIV.

Design

A systematic search in PubMed, Embase, and PsycINFO was conducted to identify peer-reviewed articles evaluating adherence to ART in older adults. Two independent reviewers screened abstracts, applied inclusion criteria, and appraised study quality. The bibliographies of qualifying studies were searched. Data were abstracted from studies by two independent authors. Meta-analyses were conducted, and adherence levels were reported as the relative risk of non-adherence in older individuals compared to younger individuals.

Results

The systematic search yielded 1,848 abstracts. Twelve studies met full inclusion criteria. The overall meta-analysis found that older age reduced risk for non-adherence by 27 % (relative risk (RR) 0.72, 95 % confidence interval (CI) 0.64–0.82). Studies assessing both short-term and long-term adherence demonstrated a significant reduction in non-adherence among older patients (RR 0.75, 95 % CI 0.64–0.87 and RR 0.65, 95 % CI 0.50–0.85, respectively).

Conclusions

Older adults with HIV have a reduced risk for non-adherence to ART than their younger counterparts. Future studies should seek to elucidate contributing factors of adherence among older individuals with HIV.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3

Similar content being viewed by others

References

  1. Brooks JT, Buchacz K, Gebo KA, Mermin J. HIV infection and older Americans: the public health perspective. Am J Public Health. 2012;2012(102):1516–26.

    Article  Google Scholar 

  2. Center for Disease Control and Prevention. HIV/AIDS Surveillance Report, 2010; vol. 22. http://www.cdc.gov/hiv/pdf/statistics_surveillance_report_vol_22.pdf (Accessed 20 July 2012).

  3. Center for Disease Control and Prevention. HIV/AIDS Surveillance Report, 2011; vol. 23. http://www.cdc.gov/hiv/topics/surveillance/resources/reports (Accessed 10 Dec 2012).

  4. Center for Disease Control and Prevention. HIV/AIDS among persons aged 50 and older; 2008. http://www.cdc.gov/hiv/topics/over50/ (Accessed 20 July 2012).

  5. Collaboration TATC. Life expectancy of individuals on combination antiretroviral therapy in high-income countries: a collaborative analysis of 14 cohort studies. Lancet. 2008;372:293–9.

    Article  Google Scholar 

  6. Abrass CK, Appelbaum JS, Boyd CM, Braithwaite RS, Broudy VC, Covinsky K, et al. HIV and aging consensus project; recommended treatment strategies for clinicians managing older patients with HIV. J Am Geriatr Soc. 2012;60:974–9.

    Article  Google Scholar 

  7. Paterson DL, Swindells S, Mohr J, Brester M, Vergis EN, Squier C, et al. Adherence to protease inhibitor therapy and outcomes in patients with HIV infection. Ann Intern Med. 2000;133:21–30.

    Article  PubMed  CAS  Google Scholar 

  8. Nguyen N, Holodniy M. HIV infection in the elderly. Clin Interv Aging. 2008;3:453–72.

    PubMed  Google Scholar 

  9. Wood E, Hogg RS, Yip B, Harrigan PR, O’Shaughnessy MV, Montaner JS. The impact of adherence on CD4 cell count responses among HIV-infected patients. J Acquir Immune Defic Syndr. 2004;35:261–8.

    Article  PubMed  Google Scholar 

  10. Maggiolo F, Ripamonti D, Arici C, Gregis G, Quinzan G, Camacho GA, et al. Simpler regimens may enhance adherence to antiretroviral in HIV-infected patients. HIV Clin Trials. 2002;3:371–8.

    Article  PubMed  Google Scholar 

  11. Dunham PJ, Karkula JM. Effects of a pharmacy-care program on adherence and outcomes. Am J Pharm Benefits. 2012;4:e8–14.

    Google Scholar 

  12. Viswanathan H, Anderson R, Thomas Iii J. Evaluation of an antiretroviral medication attitude scale and relationships between medication attitudes and medication nonadherence. AIDS Patient Care STDS. 2005;19:306–16.

    Article  PubMed  Google Scholar 

  13. Ruppar TM, Conn VS, Russell CL. Medication adherence interventions for older adults: literature review. Res Theory Nurs Pract. 2008;22:114–47.

    Article  PubMed  Google Scholar 

  14. Johnson MO, Catz SL, Remien RH, Rotheram-Borus MJ, Morin SF, Charlebois E, et al. Theory-guided, empirically supported avenues for intervention on HIV medication nonadherence: findings from the healthy living project. AIDS Patient Care STDS. 2003;17:645–56.

    Article  PubMed  Google Scholar 

  15. Holodniy M, Hornberger J, Rapoport D, Robertus K, MaCurdy TE, Lopez J, et al. Relationship between antiretroviral prescribing patterns and treatment guidelines in treatment-naive HIV-1-infected US veterans (1992–2004). J Acquir Immune Defic Syndr. 2007;44:20–9.

    Article  PubMed  Google Scholar 

  16. Barclay TR, Hinkin CH, Castellon SA, Mason KI, Reinhard MJ, Marion SD, et al. Age-associated predictors of medication adherence in HIV-positive adults: health beliefs, self-efficacy, and neurocognitive status. Health Psychol. 2007;26:40–9.

    Article  PubMed  Google Scholar 

  17. Cuzin L, Delpierre C, Gerard Sp, Massip P, Marchou B. Immunologic and clinical responses to highly active antiretroviral therapy in patients with HIV infection aged 150 years. Clin Infect Dis. 2007;45:654–7.

    Article  PubMed  Google Scholar 

  18. Sherr L, Harding R, Lampe F, Johnson M, Anderson J, Zetler S, et al. Clinical and behavioural aspects of aging with HIV infection. Psychol Health Med. 2009;14:273–9.

    Article  PubMed  Google Scholar 

  19. Stroup DF, Berlin JA, Morton SC, et al. Meta-analysis of observational studies in epidemiology: a proposal for reporting. Meta-analysis Of Observational Studies in Epidemiology (MOOSE) group. JAMA. 2000;283:2008–12.

    Article  PubMed  CAS  Google Scholar 

  20. Elema R, Mills C, Yun O, Lokuge K, Ssonko C, Nyirongo N, et al. Outcomes of a remote, decentralized health center-based HIV/AIDS antiretroviral program in Zambia, 2003 to 2007. J Int Assoc Physicians AIDS Care (Chic). 2009;8:60–7.

    Article  Google Scholar 

  21. Mathes T, Pieper D, Antoine SL, Eikermann M. Adherence-enhancing interventions for highly active antiretroviral therapy in HIV-infected patients - a systematic review. HIV Med. 2013 (Epub ahead of print).

  22. Mills EJ, Nachega JB, Buchan I, Orbinski J, et al. Adherence to antiretroviral therapy in sub-Saharan Africa and North America: a meta-analysis. JAMA. 2006;296:679–90.

    Article  PubMed  CAS  Google Scholar 

  23. U.S. Preventive Services Task Force Procedure Manual. AHRQ Publication No. 08-05118-EF; 2008. http://www.uspreventiveservicestaskforce.org/uspstf08/methods/procmanual.htm (Accessed 10 July 2012).

  24. Higgins J. Heterogeneity in meta-analyses should be expected and appropriately quantified. Int J Epidemiol. 2008;37:1158–60.

    Article  PubMed  Google Scholar 

  25. Sterne JAC, Bradburn MJ, Egger M. Meta-analysis in Stata™. In: Egger M, Smith GD, Altman DG, editors. Systematic reviews in health care: meta-analysis in context. 2nd ed. London: BMJ Publishing Group; 2008.

  26. Lyimo R, van den Boogarden J, Msoka E, et al. Measuring adherence to antiretroviral therapy in northern Tanzania: feasibility and acceptability of the Medication Event Monitoring System. BMC Public Health. 2011;11:1–20.

    Article  Google Scholar 

  27. Kyser M, Buchacz K, Bush TJ, et al. Factors associated with non-adherence to antiretroviral therapy in the SUN study. AIDS Care. 2011;23:601–11.

    Article  PubMed  Google Scholar 

  28. Hinkin CH, Hardy DJ, Mason KI, et al. Medication adherence in HIV-infected adults: effect of patient age, cognitive status, and substance abuse. AIDS. 2004;18:S19–25.

    Article  PubMed  Google Scholar 

  29. Silverberg MJ, Leyden W, Horberg MA, et al. Older age and the response to and tolerability of antiretroviral therapy. Arch Intern Med. 2007;167:684–91.

    Article  PubMed  CAS  Google Scholar 

  30. Sherr L, Lampe FC, Clucas C, et al. Self-reported non-adherence to ART and virological outcome in a multiclinic UK study. AIDS Care. 2010;22:939–45.

    Article  PubMed  CAS  Google Scholar 

  31. Simone MJ, Appelbaum J. HIV in older adults. Geriatrics. 2008;63:6–12.

    PubMed  Google Scholar 

  32. Kleeberger CA, Phair JP, Strathdee SA, et al. Determinants of heterogeneous adherence to HIV-antiretroviral therapies in the Multicenter AIDS Cohort Study. J Acquir Immune Defic Syndr. 2001;26:82–92.

    PubMed  CAS  Google Scholar 

  33. Dowshen N, D’Angelo L. Health care transition for youth living with HIV/AIDS. Pediatrics. 2011;128(4):762–71.

    Article  PubMed  Google Scholar 

  34. Greene M, Justice AC, Valcour V, et al. Management of human immunodeficiency virus infection in advanced age. JAMA. 2013;309:1397–405.

    Article  PubMed  CAS  Google Scholar 

  35. Justice AC. HIV and aging: time for a new paradigm. Curr HIV/AIDS Rep. 2010;7:69–76.

    Article  PubMed  Google Scholar 

  36. Working Group on HIV and Aging. HIV and aging: state of knowledge and areas of critical need for research. A report to the NIH Office of AIDS Research by the HIV and Aging Working Group. J Acquir Immune Defic Syndr. 2012;60:S1–18.

    Article  Google Scholar 

  37. Johnson CJ, Heckman TG, Hansen NB, et al. Adherence to antiretroviral medication in older adults living with HIV/AIDS: a comparison of alternative models. AIDS Care Psychol Soc Med Aspects AIDS/HIV. 2009;21(5):541–51.

    Article  Google Scholar 

  38. Tumbarello M, Rabagliati R, de Gaetano Donati K, Bertagnolio S, et al. Older age does not influence CD4 cell recovery in HIV-1 infected patients receiving highly active antiretroviral therapy. BMC Infect Dis. 2004;4:1–32.

    Article  Google Scholar 

  39. Shah B, Walshe L, Saple DG, et al. Adherence to antiretroviral therapy and virologic suppression among HIV-infected persons receiving care in private clinics in Mumbai, India. Clin Infect Dis. 2007;44:1235–44.

    Article  PubMed  Google Scholar 

  40. Gellad WF, Grenard JL, Marcum ZA. A systematic review of barriers to medication adherence in the elderly: looking beyond cost and regimen complexity. Am J Geriatr Pharmacother. 2011;9:11–23.

    Article  PubMed  Google Scholar 

  41. Ladefoged K, Andersson M, Koch A, et al. Living conditions, quality of life, adherence and treatment outcome in Greenlandic HIV patients. Int J Circumpolar Health. 2012;71:1–8.

    Google Scholar 

  42. Raboud J, Li M, Walmsley S, et al. Once daily dosing improves adherence to antiretroviral therapy. AIDS Behav. 2011;15:1397–409.

    Article  PubMed  Google Scholar 

  43. Kunutsor S, Evans M, Thoulass J, et al. Ascertaining baseline levels of antiretroviral therapy adherence in Uganda: a multimethod approach. J Acquir Immune Defic Syndr. 2010;55:221–4.

    Article  PubMed  Google Scholar 

  44. Pinheiro CA, de-Carvalho-Leite JC, Drachler ML, et al. Factors associated with adherence to antiretroviral therapy in HIV/AIDS patients: a cross-sectional study in Southern Brazil. Braz J Med Biol Res. 2002;35:1173–81.

    Article  PubMed  CAS  Google Scholar 

  45. Wellons MF, Sanders L, Edwards LJ, et al. HIV infection: treatment outcomes in older and younger adults. J Am Geriatr Soc. 2002;50:603–7.

    Article  PubMed  Google Scholar 

  46. Watt MH, Maman S, Golin CE, et al. Factors associated with self-reported adherence to antiretroviral therapy in a Tanzanian setting. AIDS Care. 2010;22:381–9.

    Article  PubMed  Google Scholar 

  47. Buscher A, Hartman C, Kallen MA, Giordano TP. Validity of self-report measures in assessing antiretroviral adherence of newly diagnosed, HAART-naïve HIV patients. HIV Clin Trials. 2011;12:244–54.

    Article  PubMed  Google Scholar 

  48. Fletcher M, Brundage R, Chesney M, et al. Four measures of antiretroviral medication adherence and virologic response in AIDS Clinical Trials Group Study 359. J Acquir Immune Defic Syndr. 2005;40:301–6.

    Article  PubMed  Google Scholar 

  49. Manfredi R, Chiodo F. A case–control study of virological and immunological effects of highly active antiretroviral therapy in HIV-infected patients with advanced age. AIDS. 2000;14:1475–7.

    Article  PubMed  CAS  Google Scholar 

  50. Hinkin CH, Barclay TR, Castellon SA, et al. Drug use and medication adherence among HIV-1 infected individuals. AIDS Behav. 2007;11:185–94.

    Article  PubMed  Google Scholar 

Download references

Acknowledgements

We would like to thank Dr. Paul Bain for the guidance provided for the systematic review and Mrs. Elizabeth Archambault for her editing.

Funding

This work was funded by Dr Simone’s HRSA Geriatric Academic Career Award Grant No. K01HP23811 and the NIH T35-AG038027-02 grant awarded to Dr Rudolph and Ms Ghidei. Dr Kostas is partially supported by a John A. Hartford Center of Excellence Award. Dr Rudolph is supported by a VA Rehabilitation Research Career Development Award and a VA Patient Safety Center of Inquiry award. Drs Kostas, Salow, and Rudolph receive funding from a T21 alternative to non-institutional long term care grant. Drs Salow, Paquin, Skarf, Kostas, and Rudolph are employees of the Veterans Health Administration. The views expressed are those of the authors, and do not reflect the official policies of the Veterans Health Administration or U.S. Government.

Conflict of interest

Dr Simone received an honorarium from the American Academy of HIV Medicine / American Geriatrics Society for participation in the HIV and Aging Guidance Project. Ms. Ghidei and Drs. Salow, Zimmerman, Paquin, Skarf, Kostas and Rudolph have no conflicts of interest to declare.

Author contributions

Conception and design: Ghidei, Simone, Rudolph, Bain.

Acquisition of data: Ghidei, Simone, Salow, Rudolph.

Analysis: Ghidei, Simone, Salow, Rudolph.

Interpretation of data: Ghidei, Simone, Salow, Zimmerman, Paquin, Skarf, Kostas, Rudolph.

Drafting the article: Ghidei, Simone, Salow, Zimmerman, Rudolph.

Critical revision: Ghidei, Simone, Salow, Zimmerman, Paquin, Skarf, Kostas, Rudolph, Archambault.

Final approval of the manuscript: Ghidei, Simone, Salow, Zimmerman, Paquin, Skarf, Kostas, Rudolph.

Author information

Authors and Affiliations

  1. University of Texas Southwestern Medical Center, Dallas, TX, USA

    Luwam Ghidei

  2. Geriatric Research, Education, and Clinical Center, VA Boston Healthcare System, 150 S. Huntington Ave, 02130, Boston, MA, USA

    Marci J. Salow, Allison M. Paquin, Lara M. Skarf, Tia R. M. Kostas & James L. Rudolph

  3. Department of Pharmacy, VA Boston Healthcare System, Boston, MA, USA

    Marci J. Salow, Kristin M. Zimmerman & Allison M. Paquin

  4. Division of Aging, Brigham and Women’s Hospital, Boston, MA, USA

    Mark J. Simone, Tia R. M. Kostas & James L. Rudolph

  5. Massachusetts College of Pharmacy and Health Sciences, Boston, MA, USA

    Kristin M. Zimmerman

  6. Harvard Medical School, Boston, MA, USA

    Mark J. Simone, Lara M. Skarf, Tia R. M. Kostas & James L. Rudolph

Authors
  1. Luwam Ghidei
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Mark J. Simone
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Marci J. Salow
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Kristin M. Zimmerman
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Allison M. Paquin
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Lara M. Skarf
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Tia R. M. Kostas
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. James L. Rudolph
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to James L. Rudolph.

Additional information

L. Ghidei and M. J. Simone contributed equally to the manuscript and would like to be co-first authors.

Electronic supplementary material

Below is the link to the electronic supplementary material.

Supplementary material 1 (DOC 77 kb)

Supplementary material 2 (DOC 60 kb)

Rights and permissions

Reprints and permissions

About this article

Cite this article

Ghidei, L., Simone, M.J., Salow, M.J. et al. Aging, Antiretrovirals, and Adherence: A Meta Analysis of Adherence among Older HIV-Infected Individuals. Drugs Aging 30, 809–819 (2013). https://doi.org/10.1007/s40266-013-0107-7

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s40266-013-0107-7

Keywords

Search

Navigation