Aging, Antiretrovirals, and Adherence: A Meta Analysis of Adherence among Older HIV-Infected Individuals
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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.
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.
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.
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).
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.
We would like to thank Dr. Paul Bain for the guidance provided for the systematic review and Mrs. Elizabeth Archambault for her editing.
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.
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.
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