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Antiretroviral Adherence, Drug Resistance, and the Impact of Social Determinants of Health in HIV-1 Patients in the US

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Abstract

Adherence to antiretroviral therapy (ART) is critical to achieving viral suppression. However, social determinants of health (SDoH) can undermine patient adherence to ART, resulting in drug resistance that compromises future treatment options. We assessed ART adherence and HIV-1 drug resistance at the national and state levels in the US and investigated their associations with SDoH and other HIV-related outcomes. Data were obtained from Symphony Health’s Integrated Dataverse (IDV), Monogram/LabCorp Database, as well as national and publicly available databases, including Centers for Disease Control and Prevention (CDC), American Community Survey (ACS), and J. Kaiser Family Foundation (KFF). Inferential analyses were performed to investigate associations using patient-level data, and the results were reported by state and overall within the nation. Correlations between continuous variables were estimated by the Spearman’s test, and that between continuous variable and categorical variable were estimated using one-way analysis of variance (ANOVA). State-level rates of poor adherence and resistance ranged from 26 to 55% and 20 to 54%, respectively. Female gender, non-white race, low education, poverty, and unemployment were associated with poor adherence; female gender was associated with drug resistance. Both adherence and resistance were correlated to HIV prevalence rates. Our findings suggest that US patients living with HIV face great challenges associated with poor ART adherence and HIV-1 drug resistance.

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Funding

This study was supported by Janssen Scientific Affairs, LLC.

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Authors and Affiliations

  1. Janssen Scientific Affairs, LLC, 1125 Trenton-Harbourton Road, Titusville, NJ, 08560, USA

    C. Benson, K. J. Dunn, E. Y. Wong, W. Chow, J. Song & K. Brown

  2. Amaris, Toronto, ON, Canada

    X. Wang & N. Li

  3. Amaris, Jersey City, NJ, USA

    L. Mesana

  4. Monogram Biosciences, South San Francisco, CA, USA

    J. Lai

  5. Janssen Research & Development, LLC, Titusville, NJ, USA

    H. Hardy

Authors
  1. C. Benson
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  2. X. Wang
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  3. K. J. Dunn
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  4. N. Li
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  5. L. Mesana
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  6. J. Lai
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  7. E. Y. Wong
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  8. W. Chow
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  9. H. Hardy
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  10. J. Song
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  11. K. Brown
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Corresponding author

Correspondence to W. Chow.

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Conflict of interest

C. Benson, K.J. Dunn, E.Y. Wong, W. Chow, H. Hardy, J. Song, and K. Brown are employees of Janssen and may be stockholders in Johnson & Johnson.

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Appendix

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Table 5 Additional variables investigated
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5,

Table 6 Descriptive results for the additional variables
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6 and

Table 7 Correlation results for the additional variables with adherence/resistance
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7.

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Benson, C., Wang, X., Dunn, K.J. et al. Antiretroviral Adherence, Drug Resistance, and the Impact of Social Determinants of Health in HIV-1 Patients in the US. AIDS Behav 24, 3562–3573 (2020). https://doi.org/10.1007/s10461-020-02937-8

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  • DOI: https://doi.org/10.1007/s10461-020-02937-8

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