AIDS and Behavior

, Volume 15, Issue 7, pp 1381–1396 | Cite as

Adherence to Highly Active Antiretroviral Therapy (HAART): A Meta-Analysis

  • Carmen OrtegoEmail author
  • Tania B. Huedo-Medina
  • Javier Llorca
  • Lourdes Sevilla
  • Pilar Santos
  • Elías Rodríguez
  • Michelle R. Warren
  • Javier Vejo
Original Paper


This meta-analysis synthesizes eighty-four observational studies, conducted across twenty countries, to determine the mean proportion of people who reported ≥90% adherence to prescribed highly active antiretroviral therapy (HAART) and to identify the factors associated with high levels of adherence. Eight electronic databases were searched to locate all relevant studies available by January 2010, which were then coded for sample characteristics and adherence levels. The average rate of reporting ≥90% adherent HAART adherence is 62%. However, this proportion varies greatly across studies. In particular, a greater proportion of individuals maintaining ≥90% adherence to HAART is more likely in studies with higher proportions of men who have sex with men (MSM) and lower proportions of injection drug users (IDU), with participants in an earlier stage of infection, and in studies conducted in countries characterized by lower Human Development Index (HDI) scores.


HAART Acquired immunodeficiency syndrome HIV Adherence Meta-analysis Human development 


Este metaanálisis sintetiza ochenta y cuatro estudios observacionales, realizados en veinte países, para determinar la proporción media de personas que informan de la adherencia a la Terapia Antirretroviral Altamente Activa ≥90% e identificar los factores relacionados con los niveles elevados de adherencia. Para localizar los estudios relevantes disponibles hasta enero de 2010 accedimos a ocho bases de datos electrónicas. Los estudios seleccionados se codificaron según las características de la muestra y los niveles de adherencia. Los resultados obtenidos indican que una media del 62% de las personas que tomaban Terapia Antirretroviral Altamente Activa eran adherentes en un ≥90%. Sin embargo, esta proporción varía enormemente entre los estudios. En particular, una mayor proporción de individuos que muestran una adherencia a la Terapia Antirretroviral Altamente Activa ≥90% es más frecuente en estudios con altas proporciones de hombres que mantienen relaciones sexuales con hombres y con menores proporciones de usuarios de drogas parenterales, con los participantes en un estadio más temprano de la infección y en estudios llevados a cabo en países caracterizados con puntuaciones más bajas en el índice de desarrollo humano.

Palabras clave

Terapia Antirretroviral Altamente Activa Síndrome de Inmunodeficiencia Adquirida VIH Adherencia Metaanálisis Índice de Desarrollo Humano 



We thank those study authors who made their data available for this study, SHARP (Synthesis of HIV/AIDS Research Project) team for its assistance on using the structural variables included in the study, and Soledad Fernandez who checked the English translation. This work was funded by the Fundación Marqués de Valdecilla (IFIMAV). Santander. Spain. N/Ref.: PSG10/02.

Conflicts of interest

The authors indicate having no conflicts of interest.


  1. 1.
    ONUSIDA. Global report. UNAIDS report on the global AIDS Epidemic (2010). 2010; Available at:
  2. 2.
    Hogg RS, Heath KV, Yip B, Craib KJ, O’Shaughnessy MV, Schechter MT, et al. Improved survival among HIV-infected individuals following initiation of antiretroviral therapy. JAMA. 1998;279(6):450–4.PubMedCrossRefGoogle Scholar
  3. 3.
    Mocroft A, Ledergerber B, Katlama C, Kirk O, Reiss P, d’Arminio Monforte A, et al. Decline in the AIDS and death rates in the EuroSIDA study: an observational study. Lancet. 2003;362(9377):22–9.PubMedCrossRefGoogle Scholar
  4. 4.
    Palella FJ Jr, Delaney KM, Moorman AC, Loveless MO, Fuhrer J, Satten GA, et al. Declining morbidity and mortality among patients with advanced human immunodeficiency virus infection. HIV Outpatient Study Investigators. N Engl J Med. 1998;338(13):853–60.PubMedCrossRefGoogle Scholar
  5. 5.
    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(1):21–30.PubMedGoogle Scholar
  6. 6.
    Bangsberg DR, Hecht FM, Charlebois ED, Zolopa AR, Holodniy M, Sheiner L, et al. Adherence to protease inhibitors, HIV-1 viral load, and development of drug resistance in an indigent population. AIDS. 2000;14(4):357–66.PubMedCrossRefGoogle Scholar
  7. 7.
    Bangsberg DR, Charlebois ED, Grant RM, Holodniy M, Deeks SG, Perry S. High levels of adherence do not prevent accumulation of HIV drug resistance mutations. AIDS. 2003;17:1925–32.PubMedCrossRefGoogle Scholar
  8. 8.
    Harrigan PR, Hogg RS, Dong WW, Yip B, Wynhoven B, Woodward J, et al. Predictors of HIV drug-resistance mutations in a large antiretroviral-naive cohort initiating triple antiretroviral therapy. J Infect Dis. 2005;191(3):339–47.PubMedCrossRefGoogle Scholar
  9. 9.
    Sethi AK, Celentano DD, Gange SJ, Moore RD, Gallant JE. Association between adherence to antiretroviral therapy and human immunodeficiency virus drug resistance. Clin Infect Dis. 2003;37(8):1112–8.PubMedCrossRefGoogle Scholar
  10. 10.
    Bangsberg DR, Perry S, Charlebois ED, Clark RA, Roberston M, Zolopa AR, et al. Non-adherence to highly active antiretroviral therapy predicts progression to AIDS. AIDS. 2001;15(9):1181–3.PubMedCrossRefGoogle Scholar
  11. 11.
    Lima VD, Harrigan R, Bangsberg DR, Hogg RS, Gross R, Yip B, et al. The combined effect of modern highly active antiretroviral therapy regimens and adherence on mortality over time. J Acquir Immune Defic Syndr. 2009;50(5):529–36.PubMedCrossRefGoogle Scholar
  12. 12.
    Wood E, Hogg RS, Yip B, Harrigan PR, O’Shaughnessy MV, Montaner JS. Effect of medication adherence on survival of HIV-infected adults who start highly active antiretroviral therapy when the CD4+ cell count is 0.200 to 0.350 × 10(9) cells/L. Ann Intern Med. 2003;139(10):810–6.PubMedGoogle Scholar
  13. 13.
    Bangsberg DR. Less than 95% adherence to nonnucleoside reverse-transcriptase inhibidor therapy can lead to viral suppression. Clin Infect Dis. 2006;43(7):930–41.CrossRefGoogle Scholar
  14. 14.
    Turner BJ. Adherence to antiretroviral therapy by human immunodeficiency virus-infected patients. J Infect Dis. 2002;185(Suppl 2):S143–51.PubMedCrossRefGoogle Scholar
  15. 15.
    Fogarty L, Roter D, Larson S, Burke J, Gillespie J, Levy R. Patient adherence to HIV medication regimens: a review of published and abstract reports. Patient Educ Couns. 2002;46(2):93–108.PubMedCrossRefGoogle Scholar
  16. 16.
    Press N, Tyndall MW, Wood E, Hogg RS, Montaner JS. Virologic and immunologic response, clinical progression, and highly active antiretroviral therapy adherence. J Acquir Immune Defic Syndr. 2002;31(Suppl 3):S112–7.PubMedGoogle Scholar
  17. 17.
    Raffa JD, Tossonian HK, Grebely J, Petkau AJ, DeVlaming S, Conway B. Intermediate highly active antiretroviral therapy adherence thresholds and empirical models for the development of drug resistance mutations. J Acquir Immune Defic Syndr. 2008;47(3):397–9.PubMedCrossRefGoogle Scholar
  18. 18.
    Simoni JM, Kurth AE, Pearson CR, Pantalone DW, Merrill JO, Frick PA. Self-report measures of antiretroviral therapy adherence: a review with recommendations for HIV research and clinical management. AIDS Behav. 2006;10(3):227–45.PubMedCrossRefGoogle Scholar
  19. 19.
    Muñoz-Moreno JA, Fumaz CR, Ferrer MJ, Tuldra A, Rovira T, Viladrich C, et al. Assessing self-reported adherence to HIV therapy by questionnaire: the SERAD (Self-Reported Adherence) Study. AIDS Res Hum Retroviruses. 2007;23(10):1166–75.PubMedCrossRefGoogle Scholar
  20. 20.
    Knobel H, Codina C, Miro JM, Carmona A, Garcia B, Antela A, et al. The recommendations of GESIDA/SEFH/PNS for improving adherence to antiretroviral treatment. AIDS Study Group of the Spanish Society of Hospital Pharmacy and the National Plan on AIDS of the Minister of Health and Consumers. Enferm Infecc Microbiol Clin. 2000;18(1):27–39.PubMedGoogle Scholar
  21. 21.
    Berg KM, Arnsten JH. Practical and conceptual challenges in measuring antiretroviral adherence. J Acquir Immune Defic Syndr. 2006;43(Suppl 1):S79–87.PubMedGoogle Scholar
  22. 22.
    Nieuwkerk P, Oort F. Self-report adherence to antiretroviral therapy for HIV-1 infection and virologic treatment response: a meta-analysis. JAIDS. 2005;38(4):445–8.PubMedCrossRefGoogle Scholar
  23. 23.
    Arnsten JH, Demas PA, Farzadegan H, Grant RW, Gourevitch MN, Chang CJ, et al. Antiretroviral therapy adherence and viral suppression in HIV-infected drug users: comparison of self-report and electronic monitoring. Clin Infect Dis. 2001;33(8):1417–23.PubMedCrossRefGoogle Scholar
  24. 24.
    Pearson CR, Simoni JM, Hoff P, Kurth AE, Martin DP. Assessing antiretroviral adherence via electronic drug monitoring and self-report: an examination of key methodological issues. AIDS Behav. 2007;11(2):161–73.PubMedCrossRefGoogle Scholar
  25. 25.
    Nieuwkerk PT, der Kolk IM, Prins JM, Locadia M, Sprangers MA. Self-reported adherence is more predictive of virological treatment response among patients with a lower tendency towards socially desirable responding. Antivir Ther. 2010;15(6):913–6.PubMedCrossRefGoogle Scholar
  26. 26.
    Chesney M. Adherence to HAART regimens. AIDS Patient Care STDS. 2003;17(4):169–77.PubMedCrossRefGoogle Scholar
  27. 27.
    Puigventós F, Riera M, Delibes C, Peñaranda M, de la Fuente L, Boronat A. Estudios de adhrencia a los fármacos antirretrovirales. Medicina Clínica. 2002;119(4):130–7.PubMedGoogle Scholar
  28. 28.
    Mills EJ, Nachega JB, Buchan I, Orbinski J, Attaran A, Singh S, et al. Adherence to antiretroviral therapy in sub-Saharan Africa and North America: a meta-analysis. JAMA. 2006;296(6):679–90.PubMedCrossRefGoogle Scholar
  29. 29.
    Malta M, Strathdee SA, Magnanini MM, Bastos FI. Adherence to antiretroviral therapy for human immunodeficiency virus/acquired immune deficiency syndrome among drug users: a systematic review. Addiction. 2008;103(8):1242–57.PubMedCrossRefGoogle Scholar
  30. 30.
    Stroup DF, Berlin JA, Morton SC, Olkin I, Williamson GD, Rennie D, 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(15):2008–12.PubMedCrossRefGoogle Scholar
  31. 31.
    AETC. AIDS Education and Training Centers. National Resource Center. HIV Classification: CDC and WHO Staging Systems. 2011; Available at: Accessed 23 January 2011.
  32. 32.
    Vandenbroucke JP, Von Elm E, Altman DG, Gotzsche PC, Mulrow CD, Pocock SJ, et al. Strengthening the reporting of observational studies in epidemiology (STROBE): explanation and elaboration. Gac Sanit. 2009;23(2):158.PubMedCrossRefGoogle Scholar
  33. 33.
    United Nations Development Programme. Statistics of the human development report. New York: Oxford University Press; 2008.Google Scholar
  34. 34.
    World Bank. World Development Indicators 2007. CD-ROM. Washington, DC; 2007Google Scholar
  35. 35.
    Hedges LV, Pigott TD. The power of statistical tests for moderators in meta-analysis. Psychol Methods 2004;9:426–45.Google Scholar
  36. 36.
    Lipsey MW, Wilson D. Practical meta-analysis. London: Sage; 2001.Google Scholar
  37. 37.
    Duval S, Tweedie R. Trim and Fill: a simple funnel-plot-based method of testing and adjusting for publication bias in meta-analysis. Biometrics. 2000;(56):455–63.Google Scholar
  38. 38.
    Begg CB, Mazumdar M. Operating characteristics of a rank correlation test for publication bias. Biometrics. 1994;4(50):1088–101.CrossRefGoogle Scholar
  39. 39.
    Egger M, Davey G, Schneider M, Minder C. Bias in meta-analysis detected by a simple graphical test. BMJ 1997;315:629–34.Google Scholar
  40. 40.
    Huedo T, Sánchez-Meca J, Marín F, Botella J. Assessing heterogeneity in meta-analysis: Q statistic or I 2 index? Psychol Methods. 2006;11(2):193–206.CrossRefGoogle Scholar
  41. 41.
    Hedges LV, Vevea JL. Estimating effect size under publication bias: small sample properties and robustness of a random effects selection model. J Educ Behav Stat. 1996;21:299–333.Google Scholar
  42. 42.
    Aiken LS, West SG. Multiple regression: testing and interpreting interactions. Newbury Park, CA: Sage; 1991.Google Scholar
  43. 43.
    Hedges L, Pigott TD. The power of statistical tests in meta-analysis. Psychol Methods. 2001;3(6):203–17.CrossRefGoogle Scholar
  44. 44.
    Kitahata MM, Reed SD, Dillingham PW, Van Rompaey SE, Young AA, Harrington RD, et al. Pharmacy-based assessment of adherence to HAART predicts virologic and immunologic treatment response and clinical progression to AIDS and death. Int J STD AIDS. 2004;15(12):803–10.PubMedCrossRefGoogle Scholar
  45. 45.
    Lima VD, Bangsberg DR, Harrigan PR, Deeks SG, Yip B, Hogg RS, et al. Risk of viral failure declines with duration of suppression on highly active antiretroviral therapy irrespective of adherence level. J Acquir Immune Defic Syndr. 2010;55(4):460–5.PubMedCrossRefGoogle Scholar
  46. 46.
    Moatti JP, Spire B, Kazatchkine M. Drug resistance and adherence to HIV/AIDS antiretroviral treatment: against a double standard between the north and the south. AIDS. 2004;18(Suppl 3):S55–61.PubMedCrossRefGoogle Scholar
  47. 47.
    Nachega JB, Stein DM, Lehman DA, Hlatshwayo D, Mothopeng R, Chaisson RE, et al. Adherence to antiretroviral therapy in HIV-infected adults in Soweto, South Africa. AIDS Res Hum Retroviruses. 2004;20(10):1053–6.PubMedCrossRefGoogle Scholar
  48. 48.
    Orrell C, Bangsberg DR, Badri M, Wood R. Adherence is not a barrier to successful antiretroviral therapy in South Africa. AIDS. 2003;17(9):1369–75.PubMedCrossRefGoogle Scholar
  49. 49.
    Abaasa AM, Todd J, Ekoru K, Kalyango JN, Levin J, Odeke E, et al. Good adherence to HAART and improved survival in a community HIV/AIDS treatment and care programme: the experience of The AIDS Support Organization (TASO), Kampala, Uganda. BMC Health Serv Res. 2008;8:241.PubMedCrossRefGoogle Scholar
  50. 50.
    Abellan J, Garrote M, Pulido F, Rubio R, Costa JR. Evaluation of adherence to a triple antiretroviral therapy in HIV-positive patients. Eur J Intern Med. 1999;10:202–5.CrossRefGoogle Scholar
  51. 51.
    Ammassari A, Murri R, Pezzotti P, Trotta MP, Ravasio L, De Longis P, et al. Self-reported symptoms and medication side effects influence adherence to highly active antiretroviral therapy in persons with HIV infection. J Acquir Immune Defic Syndr. 2001;28(5):445–9.PubMedGoogle Scholar
  52. 52.
    Applebaum AJ, Reilly LC, Gonzalez JS, Richardson MA, Leveroni CL, Safren SA. The impact of neuropsychological functioning on adherence to HAART in HIV-infected substance abuse patients. AIDS Patient Care STDS. 2009;23(6):455–62.PubMedCrossRefGoogle Scholar
  53. 53.
    Applebaum AJ, Richardson MA, Brady SM, Brief DJ, Keane TM. Gender and other psychosocial factors as predictors of adherence to Highly Active Antiretroviral Therapy (HAART) in adults with comorbid HIV/AIDS, psychiatric and substance-related disorder. AIDS Behav. 2009;13(1):60–5.PubMedCrossRefGoogle Scholar
  54. 54.
    Assis F, Puig-Junoy J, Fátima P, Gracas M, Drew M. Análisis coste-efectividad de la adhesión inicial a la terapia antirretroviral entre individuos infectados por el VIH en Belo horizonte (Brasil). Revista Española Salud Pública. 2006;80(1):41–54.CrossRefGoogle Scholar
  55. 55.
    Barfod TS, Gerstoft J, Rodkjaer L, Pedersen C, Nielsen H, Moller A, et al. Patients’ answers to simple questions about treatment satisfaction and adherence and depression are associated with failure of HAART: a cross-sectional survey. AIDS Patient Care STDS. 2005;19(5):317–25.PubMedCrossRefGoogle Scholar
  56. 56.
    Beyene KA, Gedif T, Gebre-Mariam T, Engidawork E. Highly active antiretroviral therapy adherence and its determinants in selected hospital from south and central Ethiopia. Pharmacoepidemiol Drug Saf. 2009;18(11):1007–15.PubMedCrossRefGoogle Scholar
  57. 57.
    der Kolk IM, Sprangers MA, van der Ende M, Schreij G, de Wolf F, Nieuwkerk PT. Lower perceived necessity of HAART predicts lower treatment adherence and worse virological response in the ATHENA cohort. J Acquir Immune Defic Syndr. 2008;49(4):460–2.CrossRefGoogle Scholar
  58. 58.
    Brañas F, Berenguer J, Sanchez-Conde M, Lopez-Bernaldo de Quiros JC, Miralles P, Cosin J, et al. The eldest of older adults living with HIV: response and adherence to highly active antiretroviral therapy. Am J Med. 2008;121(9):820–4.PubMedCrossRefGoogle Scholar
  59. 59.
    Brown S, Friedland GH, Bodasing U. Assessment of adherence to antiretroviral therapy in HIV-infected Southe African adults. XV International AIDS Conference 2004 July 11–16, 2004 Bangkok, Thailand (Abstract B12223).Google Scholar
  60. 60.
    Buathong N, Hiransuthikul N, Tangwongchai S, Komoltri C. Association between depression and adherence to highly active antiretroviral therapy among adult HIV infected patients in Thailand. Asian Biomed. 2009;3(2):127–33.Google Scholar
  61. 61.
    Byakika-Tusiime J, Oyugi JH, Tumwikirize WA, Katabira ET, Mugyenyi PN, Bangsberg DR. Adherence to HIV antiretroviral therapy in HIV+ Ugandan patients purchasing therapy. Int J STD AIDS. 2005;16(1):38–41.PubMedCrossRefGoogle Scholar
  62. 62.
    Carballo E, Cadarso-Suarez C, Carrera I, Fraga J, de la Fuente J, Ocampo A, et al. Assessing relationships between health-related quality of life and adherence to antiretroviral therapy. Qual Life Res. 2004;13(3):587–99.PubMedCrossRefGoogle Scholar
  63. 63.
    de Carvalho CV, Duarte DB, Merchan-Hamann E, Bicudo E, Laguardia J. Predictors of compliance with highly active antiretroviral therapy in Brasilia, Distrito Federal, Brazil, 1999–2000. Cad Saude Publica. 2003;19(2):593–604.PubMedCrossRefGoogle Scholar
  64. 64.
    Codina J, Tuset M, Ibarra O, Delgado O, Morancho O, García B. Evaluación de un programa de atención farmacéutica dirigido a mejorar la adherencia al tratamiento antirretroviral. Farmacia Hospitalaria 2004;Supl. 1(28):25–32.Google Scholar
  65. 65.
    Cruess DG, Minor S, Antoni MH, Millon T. Utility of the Millon Behavioral Medicine Diagnostic (MBMD) to predict adherence to highly active antiretroviral therapy (HAART) medication regimens among HIV-positive men and women. J Pers Assess. 2007;89(3):277–90.PubMedCrossRefGoogle Scholar
  66. 66.
    Daniel OJ, Ogun SA, Odusoga OL, et al. Adherence pattern to ARV drugs among AIDS patients on self-purchased drugs and those on free medications in sagamu, Nigeria. XV International AIDS Conference 2004 July 11–16; 2004 Bangkok (Thailand) (WePeB5768).Google Scholar
  67. 67.
    Diabaté S, Alary M, Koffi CK. Determinants of adherence to highly active antiretroviral therapy among HIV-1-infected patients in Cote d’Ivoire. AIDS. 2007;21(13):1799–803.PubMedCrossRefGoogle Scholar
  68. 68.
    Eholié SP, Tanon A, Polneau S, Ouiminga M, Djadji A, Kangah-Koffi C, et al. Field adherence to highly active antiretroviral therapy in HIV-infected adults in Abidjan, Cote d’Ivoire. J Acquir Immune Defic Syndr. 2007;45(3):355–8.PubMedGoogle Scholar
  69. 69.
    Escobar I, Campo M, Martin J, Fernandez-Shaw C, Pulido F, Rubio R. Factors affecting patient adherence to highly active antiretroviral therapy. Ann Pharmacother. 2003;37(6):775–81.PubMedCrossRefGoogle Scholar
  70. 70.
    Fong OW, Ho CF, Fung LY, Lee FK, Tse WH, Yuen CY, et al. Determinants of adherence to highly active antiretroviral therapy (HAART) in Chinese HIV/AIDS patients. HIV Med. 2003;4(2):133–8.PubMedCrossRefGoogle Scholar
  71. 71.
    Fumaz CR, Munoz-Moreno JA, Molto J, Ferrer MJ, Lopez-Blazquez R, Negredo E, et al. Sustained antiretroviral treatment adherence in survivors of the pre-HAART era: attitudes and beliefs. AIDS Care. 2008;20(7):796–805.PubMedCrossRefGoogle Scholar
  72. 72.
    Garciá de Olalla P, Knobel H, Carmona A, Guelar A, Lopez-Colomes JL, Cayla JA. Impact of adherence and highly active antiretroviral therapy on survival in HIV-infected patients. J Acquir Immune Defic Syndr. 2002;30(1):105–10.PubMedGoogle Scholar
  73. 73.
    Gibbie T, Hay M, Hutchison CW, Mijch A. Depression, social support and adherence to highly active antiretroviral therapy in people living with HIV/AIDS. Sex Health. 2007;4(4):227–32.PubMedCrossRefGoogle Scholar
  74. 74.
    Gordillo V, del Amo J, Soriano V, Gonzalez-Lahoz J. Sociodemographic and psychological variables influencing adherence to antiretroviral therapy. AIDS. 1999;13(13):1763–9.PubMedCrossRefGoogle Scholar
  75. 75.
    Guaraldi G, Murri R, Orlando G, Orlandi E, Sterrantino G, Borderi M, et al. Morphologic alterations in HIV-infected people with lipodystrophy are associated with good adherence to HAART. HIV Clin Trials. 2003;4(2):99–106.PubMedCrossRefGoogle Scholar
  76. 76.
    Harvey KM, Carrington D, Duncan J, Figueroa JP, Hirschorn L, Manning D, et al. Evaluation of adherence to highly active antiretroviral therapy in adults in Jamaica. West Indian Med J. 2008;57(3):293–7.PubMedGoogle Scholar
  77. 77.
    Herraiz F, Villamarín F, Chamarro A. Correlatos psicosociales de la adhesión al tratamiento antirretroviral en el Centro Penitenciariode hombres de Barcelona. Rev esp sanid penit. 2008;10(3):80–9.CrossRefGoogle Scholar
  78. 78.
    Hicks PL, Mulvey KP, Chander G, Fleishman JA, Josephs JS, Korthuis PT, et al. The impact of illicit drug use and substance abuse treatment on adherence to HAART. AIDS Care. 2007;19(9):1134–40.PubMedCrossRefGoogle Scholar
  79. 79.
    Horne R, Cooper V, Gellaitry G, Date HL, Fisher M. Patients’ perceptions of highly active antiretroviral therapy in relation to treatment uptake and adherence: the utility of the necessity-concerns framework. J Acquir Immune Defic Syndr. 2007;45(3):334–41.PubMedGoogle Scholar
  80. 80.
    Hosseinipour MC, Neuhann F, Kanyama C, et al. Safety and efficacy of D4T/3Tc/NVP hmong HIV positive adults in Lilongwe, Malawi. eJournal of International AIDS Conference 2004 July 11–16.Google Scholar
  81. 81.
    Idigbe EO, Adewole TA, Eisen G, Kanki P, Odunukwe NN, Onwujekwe DI, et al. Management of HIV-1 infection with a combination of nevirapine, stavudine, and lamivudine: a preliminary report on the Nigerian antiretroviral program. J Acquir Immune Defic Syndr. 2005;40(1):65–9.PubMedCrossRefGoogle Scholar
  82. 82.
    Iliyasu Z, Kabir M, Abubakar IS, et al. Compliance to antiretroviral therapy among AIDS patients in Aminu Kano Teaching Hospital, Kano, Nigeria. Niger J Med. 2005;14:290–4.PubMedGoogle Scholar
  83. 83.
    Ines SM, Moralejo L, Marcos M, Fuertes A, Luna G. Adherence to highly active antiretroviral therapy in HIV-infected inmates. Curr HIV Res. 2008;6(2):164–70.PubMedCrossRefGoogle Scholar
  84. 84.
    Kalanzi D, Nansikombi J. Texas Woman’s U., US. Adherence behavior and the impact of HAART on quality of life of Ugandan adults; 2008.Google Scholar
  85. 85.
    Kerr T, Palepu A, Barness G, Walsh J, Hogg R, Montaner J, et al. Psychosocial determinants of adherence to highly active antiretroviral therapy among injection drug users in Vancouver. Antivir Ther. 2004;9(3):407–14.PubMedGoogle Scholar
  86. 86.
    Kleeberger CA, Buechner J, Palella F, Detels R, Riddler S, Godfrey R, et al. Changes in adherence to highly active antiretroviral therapy medications in the Multicenter AIDS Cohort Study. AIDS. 2004;18(4):683–8.PubMedCrossRefGoogle Scholar
  87. 87.
    Knobel H, Alonso J, Casado JL, Collazos J, González J, Ruiz I, et al. Validation of a simplified medication adherence questionaire in a large cohorte of HIV-infected patients: the GEEMA study. AIDS 2002;16:605–13.Google Scholar
  88. 88.
    Knobel H, Guelar A. Estrategias para optimizar la adherencia al tratamiento antirretroviral. Intervenciones en la pauta terapéutica. Enfermedades Infecciosas y Microbiología Clínica. 2004;2(22):106–12.Google Scholar
  89. 89.
    Kumar V, Encinosa W. Effects of antidepressant treatment on antiretroviral regimen adherence among depressed HIV-infected patients. Psychiatr Q. 2009;80(3):131–41.PubMedCrossRefGoogle Scholar
  90. 90.
    Ladero Martín L, Orejudo Hernández S, Carrobles Isabel J, Malo Aznar C. Consumo de drogas y adherencia a la terapia antirretroviral de pacientes en programa de mantenimiento con metadona. Adicciones. 2005;17(3):203–14.Google Scholar
  91. 91.
    Lattuada E, Lanzafame M, Gottardi M, Corsini F, Concia E, Vento S. Initial hospitalization and adherence to highly active antiretroviral therapy. Clin Infect Dis. 2008;46(6):957–8.PubMedCrossRefGoogle Scholar
  92. 92.
    Lee SS, Ma K, Chu EKY, Wong KH. The phenomenon of missing doses in a cohort of HIV patients with good adherence to highly active antiretroviral therapy. Int J STD AIDS. 2007;18(3):167–70.PubMedCrossRefGoogle Scholar
  93. 93.
    Lima VD, Harrigan R, Murray M, Moore DM, Wood E, Hogg RS, et al. Differential impact of adherence on long-term treatment response among naive HIV-infected individuals. AIDS. 2008;22(17):2371–80.PubMedCrossRefGoogle Scholar
  94. 94.
    Marco A, Gallego C, Lonca M, Pérez-Amigó P, Monfort A, Gramunt J, et al. Estudio multicéntrico penitenciario sobre adherencia a corto plazo de una pauta antirretroviral con Nelfinavir y/o Saquinavir. Rev esp sanid penit. 2002;4(1):4–9.Google Scholar
  95. 95.
    Martín MT, del Cacho E, López E, Codina C, Tuset M, de Lazzari E, et al. Reacciones adversas del tratamiento antirretroviral relación entre los síntomas percibidos y el cumplimiento terapéutico. Medicina Clínica. 2007;4(129):127–33.Google Scholar
  96. 96.
    Martin J, Escobar I, Rubio R, Sabugal G, Cascon J, Pulido F. Study of the validity of a questionnaire to assess the adherence to therapy in patients infected by HIV. HIV Clin Trials. 2001;2(1):31–7.PubMedCrossRefGoogle Scholar
  97. 97.
    Martín V,Ortega L, Pérez MR, Mostaza JL, Ortiz de Urbina JJ, Rodriguez M, et al. Factores predictores de no adherencia al tratamiento antirretroviral de gran actividad. Enferm infecc microbiol clín (Ed impr) 2002;20(10):491–7.Google Scholar
  98. 98.
    Merenstein D, Schneider MF, Cox C, Schwartz R, Weber K, Robison E, et al. Association of child care burden and household composition with adherence to highly active antiretroviral therapy in the Women’s Interagency HIV Study. AIDS Patient Care STDS. 2009;23(4):289–96.PubMedCrossRefGoogle Scholar
  99. 99.
    Mohammed H, Kieltyka L, Richardson-Alston G, Magnus M, Fawal H, Vermund SH, et al. Adherence to HAART among HIV-infected persons in rural Louisiana. AIDS Patient Care STDS. 2004;18(5):289–96.PubMedCrossRefGoogle Scholar
  100. 100.
    Moralejo L, Ines S, Marcos M, Fuertes A, Luna G. Factors influencing adherence to highly active antiretroviral therapy in Spain. Curr HIV Res. 2006;4(2):221–7.PubMedCrossRefGoogle Scholar
  101. 101.
    Morillo R, Abdel L, Márquez E, Martínez I, Artacho S, Almeida C, et al. Análisis de las causas de suspensión del régimen antirretroviral simplificado abacavir, lamivudina y zidovudina. Farmacia Hospitalaria. 2005;29(3):164–70.CrossRefGoogle Scholar
  102. 102.
    Nieuwkerk PT, Sprangers MA, Burger DM, Hoetelmans RM, Hugen PW, Danner SA, et al. Limited patient adherence to highly active antiretroviral therapy for HIV-1 infection in an observational cohort study. Arch Intern Med. 2001;161(16):1962–8.PubMedCrossRefGoogle Scholar
  103. 103.
    Owen-Smith A, Diclemente R, Wingood G. Complementary and alternative medicine use decreases adherence to HAART in HIV-positive women. AIDS Care. 2007;19(5):589–93.PubMedCrossRefGoogle Scholar
  104. 104.
    Parruti G, Manzoli L, Toro PM, D’Amico G, Rotolo S, Graziani V, et al. Long-term adherence to first-line highly active antiretroviral therapy in a hospital-based cohort: predictors and impact on virologic response and relapse. AIDS Patient Care STDS. 2006;20(1):48–56.PubMedCrossRefGoogle Scholar
  105. 105.
    Penedo FJ, Gonzalez JS, Dahn JR, Antoni M, Malow R, Costa P, et al. Personality, quality of life and HAART adherence among men and women living with HIV/AIDS. J Psychosom Res. 2003;54(3):271–8.PubMedCrossRefGoogle Scholar
  106. 106.
    Peretti-Watel P, Spire B, Pierret J, Lert F, Obadia Y. VESPA Group. Management of HIV-related stigma and adherence to HAART: evidence from a large representative sample of outpatients attending French hospitals (ANRS-EN12-VESPA 2003). AIDS Care. 2006;18(3):254–61.PubMedCrossRefGoogle Scholar
  107. 107.
    Pradier C, Carrieri P, Bentz L, Spire B, Dellamonica P, Moreau J, et al. Impact of short-term adherence on virological and immunological success of HAART: a case study among French HIV-infected IDUs. Int J STD AIDS. 2001;12(5):324–8.PubMedCrossRefGoogle Scholar
  108. 108.
    Protopopescu C, Raffi F, Roux P, Reynes J, Dellamonica P, Spire B, et al. Factors associated with non-adherence to long-term highly active antiretroviral therapy: a 10 year follow-up analysis with correction for the bias induced by missing data. J Antimicrob Chemother. 2009;63(3):599–606.CrossRefGoogle Scholar
  109. 109.
    Quiros-Roldan E, Torti C, Lapadula G, Ladisa N, Micheli V, Patroni A, et al. Adherence and plasma drug concentrations are predictors of confirmed virologic response after 24-week salvage highly active antiretroviral therapy. AIDS Patient Care STDS. 2007;21(2):92–9.PubMedCrossRefGoogle Scholar
  110. 110.
    Ramadhani HO, Thielman N, Landman K, et al. Predictors of maladherence hmong patients receiving fixed dose combination Statvudine/Lamivudine/Nevirapine in Northern Tanzania. 2006 February 5–8, Denver, Colo.Google Scholar
  111. 111.
    Remor E. Infección por VIH y Sida: Características psicológicas y adhesión al tratamiento. 2000 Dpto. Psicología Biológica y de la Salud. Universidad Autonoma Madrid.Google Scholar
  112. 112.
    Riera M, la Fuente L, Castanyer B, Puigventós F, Villalonga C, Ribas MA, et al. Adherencia a los fármacos antirretrovirales medida por la concentración de fármacos y el recuento de comprimidos. Variables relacionadas con una mala adherencia. Medicina Clínica. 2002;119(8):286–92.PubMedGoogle Scholar
  113. 113.
    Roca B, Lloria N. Adherence and viral load response to HAART. AIDS. 2000;14:P109.CrossRefGoogle Scholar
  114. 114.
    Roca B, Lapuebia C, Edo MT, Ballester R. Causes of non-adherence to HAART. AIDS. 2000;14:P127.CrossRefGoogle Scholar
  115. 115.
    Rodríguez Torné G, Iranzu Aperte M, Berrocal Javato M, Gómez-Serranillo Reus M. Adherencia al tratamiento antirretroviral: Repercusión del número de tomas diarias. Revista de la O F I L. 2007;17(3):15–20.Google Scholar
  116. 116.
    Royal SW, Kidder DP, Patrabansh S, Wolitski RJ, Holtgrave DR, Aidala A, et al. Factors associated with adherence to highly active antiretroviral therapy in homeless or unstably housed adults living with HIV. AIDS Care. 2009;21(4):448–55.PubMedCrossRefGoogle Scholar
  117. 117.
    Ruiz I, Orly A, Prada JL, Rodríguez J, Causse M, López MA, et al. Impacto de los factores demográficos y psicosociales en la no adherencia a los fármacos antirretrovirales. Enfermedades infecciosas y microbiologia clinica. 2006;24(6):373–8.CrossRefGoogle Scholar
  118. 118.
    Shaahu VN, Lawoyin TO, Sangowawa AO. Adherence to highly active antiretroviral therapy (HAAT) at a Federal Medical Centre. Afr J Med Med Sci. 2008;37(1):29–36.PubMedGoogle Scholar
  119. 119.
    Sledjeski EM, Delahanty DL, Bogart LM. Incidence and impact of posttraumatic stress disorder and comorbid depression on adherence to HAART and CD4+ counts in people living with HIV. AIDS Patient Care STDS. 2005;19(11):728–36.PubMedCrossRefGoogle Scholar
  120. 120.
    Tornero C, Cuenca A, Nolasco A, Soler E, Rull S. Gasto farmacéutico en medicación antirretroviral y posibilidades de optimización. Anales de Medicina Interna. 2005;22(12):575–8.Google Scholar
  121. 121.
    Trotta MP, Ammassari A, Cozzi-Lepri A, Zaccarelli M, Castelli F, Narciso P, et al. Adherence to highly active antiretroviral therapy is better in patients receiving non-nucleoside reverse transcriptase inhibitor-containing regimens than in those receiving protease inhibitor-containing regimens. AIDS. 2003;17(7):1099–102.PubMedCrossRefGoogle Scholar
  122. 122.
    Tuldrà A, Ferrer MJ, Fumaz C, Bayés R, Paredes R, Burger DM, et al. Monitoring adherence to HIV therapy. Arch Intern Med. 1999;159:1376–7.PubMedCrossRefGoogle Scholar
  123. 123.
    van Oosterhout JJ, Bodasing N, Kumwenda JJ, Nyirenda C, Mallewa J, Cleary PR, et al. Evaluation of antiretroviral therapy results in a resource-poor setting in Blantyre, Malawi. Trop Med Int Health. 2005;10(5):464–70.PubMedCrossRefGoogle Scholar
  124. 124.
    Ventura Cerdá J, Minguez Gallego C, Fernández Villalba E, Alós Almiñana M, Andrés Soler J. Escala simplificada para detectar problemas de adherencia (ESPA) al tratamiento antirretroviral. Farmacia Hospitalaria. 2006;30(3):171–6.PubMedCrossRefGoogle Scholar
  125. 125.
    Viciana P, Rubio R, Ribera E, Knobel H, Iribarren JA, Arribas JR, et al. Estudio longitudinal de adherencia, satisfacción y efectividad del tratamiento antirretroviral administrado una vez al día, frente a dos veces al día, en una cohorte española de infectados por el VIH (estudio CUVA: cualquiera una vez al día). Enferm infecc microbiol clín (Ed impr). 2008;26(3):127–34.CrossRefGoogle Scholar
  126. 126.
    Vriesendorp R, Cohen A, Kristanto P, Vrijens B, Rakesh P, Anand B, et al. Adherence to HAART therapy measured by electronic monitoring in newly diagnosed HIV patients in Botswana. Eur J Clin Pharmacol. 2007;63(12):1115–21.PubMedCrossRefGoogle Scholar
  127. 127.
    Weiss L, French T, Finkelstein R, Waters M, Mukherjee R, Agins B. HIV-related knowledge and adherence to HAART. AIDS Care. 2003;15(5):673–9.PubMedCrossRefGoogle Scholar
  128. 128.
    Williams M, Clarke T, Williams P, Barton EN. The mean levels of adherence and factors contributing to non-adherence in patients on highly active antiretroviral therapy. West Indian Med J. 2007;56(3):270–4.PubMedGoogle Scholar
  129. 129.
    Wood E, Montaner JS, Yip B, Tyndall MW, Schechter MT, O’Shaughnessy MV, et al. Adherence and plasma HIV RNA responses to highly active antiretroviral therapy among HIV-1 infected injection drug users. CMAJ. 2003;169(7):656–61.PubMedGoogle Scholar
  130. 130.
    Zorrilla CD, Santiago LE, Knubson D, Liberatore K, Estronza G, Colon O, et al. Greater adherence to highly active antiretroviral therapy (HAART) between pregnant versus non-pregnant women living with HIV. Cell Mol Biol (Noisy-le-grand). 2003;49(8):1187–92.Google Scholar

Copyright information

© Springer Science+Business Media, LLC 2011

Authors and Affiliations

  • Carmen Ortego
    • 1
    Email author
  • Tania B. Huedo-Medina
    • 2
  • Javier Llorca
    • 3
    • 4
    • 5
  • Lourdes Sevilla
    • 1
  • Pilar Santos
    • 1
  • Elías Rodríguez
    • 1
  • Michelle R. Warren
    • 2
  • Javier Vejo
    • 1
  1. 1.Nursing DepartmentUniversity of CantabriaSantanderSpain
  2. 2.Center for Health, Intervention, and Prevention (CHIP)University of ConnecticutStorrsUSA
  3. 3.Group of Epidemiology and Computational BiologyUniversity of CantabriaCantabriaSpain
  4. 4.CIBER Epidemiología y Salud Pública (CIBERESP)BarcelonaSpain
  5. 5.IFIMAVSantanderSpain

Personalised recommendations