2049. Adherence to Antiretroviral Therapy in Veterans and Non-veterans with HIV/AIDS
JM Mrus, Cincinnati VAMC and University of Cincinnati Medical Center, SN Sherman, SNS Consulting and University of Cincinnati Medical Center, CM Puchalski, George Washington University School of Medicine and Health Sciences, ML Ho, University of Cincinnati Medical Center, RW Hornung, University of Cincinnati Medical Center, SL Fultz, Center for Health Equities Research and Promotion, VA Pittsburgh Healthcare System, AC Justice, Center for Health Equities Research and Promotion, VA Pittsburgh Healthcare System, KL Mandell, University of Cincinnati Medical Center, J Tsevat, Cincinnati VAMC and University of Cincinnati Medical Center,

Objectives: To compare adherence rates between HIV-infected veterans and non-veterans in a multicenter cohort.

Methods: Self-reported adherence was assessed between 9/01 and 9/02 using a modified ACTG measure in a cohort of 55 veterans and 177 non-veterans with HIV/AIDS from 4 clinical sites in 3 cities.  Adherence was evaluated using 4 distinct cut-offs: 100% adherent for at least the last 6 months, 100% adherent for the last 4 days, at least 95% adherent for the last 4 days, and at least 80% adherent for the last 4 days.  Univariate analyses were performed using the chi-square test. Multivariable analyses that included CD4 cell count and demographic covariates were performed using logistic regression.

Results: The veteran and non-veteran samples included similar proportions of minorities and of participants in each CD4+ cell count strata.  However, the veteran population was somewhat older on average and included relatively fewer females, more heterosexuals, and more participants with a history of intravenous drug use than the non-veteran population. 78% of veterans and 82% of non-veterans reported taking antiretroviral medications.  32.6% of veterans and 33.3% of non-veterans reported that they had not missed any antiretroviral doses in the last 6 months; 67.4% veterans and 68.3% of non-veterans reported 100% adherence in the last 4 days; 72.5% of veterans and 71.6% of non-veterans reported at least 95% adherence in the last 4 days; and 85.0% of veterans and 90.0% of non-veterans reported at least 80% adherence in the last 4 days.  None of the adherence outcomes were statistically different in univariate or multivariable analyses between veteran and non-veteran populations.  Neither CD4 cell count nor any of the demographic factors were significantly associated with the adherence outcomes.

Conclusions: Veteran and non-veteran participants with HIV/AIDS reported similarly high adherence rates for antiretroviral medications. Demographic characteristics of the participants were not statistically associated with adherence.

Impact: Patients’ demographic characteristics have been shown to influence physicians’ estimates of antiretroviral adherence and subsequent treatment decisions. We found no association between demographic characteristics and antiretroviral adherence; therefore, estimates of antiretroviral adherence should not be based on patients’ age, gender, race, sexual orientation, drug use history, or veteran status.