Cardiovascular medication adherence testing in patients living with HIV: A single-centre observational study.
HIV
adherence
cardiovascular disease
comorbidity
statins
Journal
HIV medicine
ISSN: 1468-1293
Titre abrégé: HIV Med
Pays: England
ID NLM: 100897392
Informations de publication
Date de publication:
24 Sep 2024
24 Sep 2024
Historique:
received:
29
06
2024
accepted:
02
09
2024
medline:
24
9
2024
pubmed:
24
9
2024
entrez:
24
9
2024
Statut:
aheadofprint
Résumé
People with HIV (PWH) are at an increased risk of developing cardiovascular disease (CVD) compared to HIV-negative individuals. We sought to evaluate the adherence to medications for CVD in PWH and identify factors associated with non-adherence to these medications. We conducted a cross-sectional study at the University Hospitals of Leicester NHS Trust between 16 April 2019 and 8 November 2022. We recruited consecutive PWH, who were attending a routine follow-up outpatient appointment and were prescribed at least one medication for CVD. In addition, we included urinary adherence results of patients with samples collected as part of routine clinical care. We used liquid chromatography-tandem mass spectrometry (LC-MS/MS) to assess if their prescribed medications (antihypertensives, diuretics, beta-blockers, lipid-lowering agents, antiplatelets, anticoagulants, antidiabetic medications) were present in the participant's urine sample. Multivariable models were used to identify demographic or clinical features that were associated with non-adherence. A total of 162 PWH were included in the analysis. Median age was 55 [interquartile range (IQR): 50-61] years, 63% were male, average time living with HIV was 15 years (IQR: 11-19) and the majority (98%) had an undetectable HIV viral load. In approximately one-third of patients (59/162), at least one prescribed medication of interest was not detected in urine. Non-adherence to lipid-lowering agents was common (35/88, 40%). On multivariable logistic regression, the number of prescribed cardiovascular medications, was associated with medication non-adherence [medication non-adherence, per one medication increase: adjusted odds ratio (95% confidence interval) = 1.78 (1.34-2.36); p < 0.001]. We found sub-optimal adherence to medications for CVD in PWH. In order to maximize the clinical benefit of statin therapy in PWH, factors requiring consideration include: improved medication adherence, awareness of polypharmacy, educational interventions and quantitative assessment of sub-optimal adherence through chemical adherence testing.
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Subventions
Organisme : NIHR Leicester Biomedical Research Centre
Organisme : National Institute for Health and Care Research
Organisme : Applied Research Collaboration East Midlands
Organisme : NIHR Doctoral Research Fellowship
ID : NIHR302338
Informations de copyright
© 2024 The Author(s). HIV Medicine published by John Wiley & Sons Ltd on behalf of British HIV Association.
Références
Maggi P, De Socio GV, Cicalini S, et al. Statins and aspirin in the prevention of cardiovascular disease among HIV‐positive patients between controversies and unmet needs: review of the literature and suggestions for a friendly use. AIDS Res Ther. 2019;16(1):11.
Martin‐Iguacel R, Llibre JM, Friis‐Moller N. Risk of cardiovascular disease in an aging HIV population: where are we now? Curr HIV/AIDS Rep. 2015;12(4):375‐387.
Shah A, Martin V, Brown A, et al. Mortality among people with HIV in the UK in 2021: findings from the national HIV mortality review. HIV Med. 2023;24(S3):21‐106.
Muiruri C, Sico IP, Schexnayder J, et al. Why do people living with HIV adhere to antiretroviral therapy and not comorbid cardiovascular disease medications? A Qualitative Inquiry. Patient Prefer Adherence. 2020;14:985‐994.
Achhra AC, Lyass A, Borowsky L, et al. Assessing cardiovascular risk in people living with HIV: current tools and limitations. Curr HIV/AIDS Rep. 2021;18(4):271‐279.
Triant VA, Perez J, Regan S, et al. Cardiovascular risk prediction functions underestimate risk in HIV infection. Circulation. 2018;137(21):2203‐2214.
Grinspoon SK, Fitch KV, Zanni MV, et al. Pitavastatin to prevent cardiovascular disease in HIV infection. N Engl J Med. 2023;389:687‐699.
Kolandaivelu K, Leiden BB, O'Gara PT, Bhatt DL. Non‐adherence to cardiovascular medications. Eur Heart J. 2014;35(46):3267‐3276.
Lane D, Beishon L, Sharma V, et al. High non‐adherence rates to secondary prevention by chemical adherence testing in patients with TIA. J Stroke Cerebrovasc Dis. 2022;31(9):106665.
Osman H, Lane D, Bernieh D, et al. An innovative chemical adherence test demonstrates very high rates of nonadherence to Oral cardio‐metabolic medications. Kidney Int Rep. 2023;8(12):2818‐2821.
Tomaszewski M, White C, Patel P, et al. High rates of non‐adherence to antihypertensive treatment revealed by high‐performance liquid chromatography‐tandem mass spectrometry (HP LC‐MS/MS) urine analysis. Heart. 2014;100(11):855‐861.
Gupta P, Patel P, Štrauch B, et al. Risk factors for nonadherence to antihypertensive treatment. Hypertension. 2017;69(6):1113‐1120.
Lane D, Patel P, Khunti K, Gupta P. Objective measures of non‐adherence in cardiometabolic diseases: a review focused on urine biochemical screening. Patient Prefer Adherence. 2019;13:537‐547.
Osman H, Alghamdi R, Gupta P. Review of the methods to measure non‐adherence with a focus on chemical adherence testing. Translational Metabolic Syndrome Research. 2021;5:5‐9.
van Schoonhoven AV, van Asselt ADI, Tomaszewski M, et al. Cost‐utility of an objective biochemical measure to improve adherence to antihypertensive treatment. Hypertension. 2018;72(5):1117‐1124.
Gupta P, Patel P, Horne R, Buchanan H, Williams B, Tomaszewski M. How to screen for non‐adherence to antihypertensive therapy. Curr Hypertens Rep. 2016;18(12):89.
Murray GJ, Danaceau JP. Simultaneous extraction and screening of diuretics, beta‐blockers, selected stimulants and steroids in human urine by HPLC‐MS/MS and UPLC‐MS/MS. J Chromatogr B Analyt Technol Biomed Life Sci. 2009;877(30):3857‐3864.
Lawson AJ, Shipman KE, George S, Dasgupta I. A novel ‘Dilute‐and‐Shoot’ liquid chromatography‐tandem mass spectrometry method for the screening of antihypertensive drugs in urine. J Anal Toxicol. 2016;40(1):17‐27.
Burns AD, Lane D, Cole R, Patel P, Gupta P. Cardiovascular medication stability in urine for non‐adherence screening by LC‐MS‐MS. J Anal Toxicol. 2019;43(4):325‐329.
Schesing KB, Chia R, Elwood B, et al. Assessment of patient and provider attitudes towards therapeutic drug monitoring to improve medication adherence in low‐income patients with hypertension: a qualitative study. BMJ Open. 2020;10(11):e039940.
Batchelder AW, Gonzalez JS, Berg KM. Differential medication nonadherence and illness beliefs in co‐morbid HIV and type 2 diabetes. J Behav Med. 2014;37(2):266‐275.
Crockett KB, Wen Y, Overton ET, et al. One‐year statin persistence and adherence in adults with HIV in the United States. J Clin Lipidol. 2021;15(1):181‐191.
Jackson IL, Okonta JM, Ukwe CV. HIV‐ and hypertension‐related knowledge and medication adherence in HIV seropositive persons with hypertension. J Public Health (Oxf). 2022;44(1):e79‐e87.
Langness J, Cook PF, Gill J, Boggs R, Netsanet N. Comparison of adherence rates for antiretroviral, blood pressure, or mental health medications for HIV‐positive patients at an academic medical center outpatient pharmacy. J Manag Care Spec Pharm. 2014;20(8):809‐814.
Waters L, Gilleece Y, Alagaratnam J, et al. BHIVA Rapid Guidance on the Use of Statins for Primary Prevention of Cardiovascular Disease in People Living with HIV. British HIV Association; 2024.
Denicolò S, Reinstadler V, Keller F, et al. Non‐adherence to cardiometabolic medication as assessed by LC‐MS/MS in urine and its association with kidney and cardiovascular outcomes in type 2 diabetes mellitus. Diabetologia. 2024;67(7):1283‐1294.
Patel P, Gupta P, Burns A, et al. Biochemical urine testing of adherence to cardiovascular medications reveals high rates of nonadherence in people attending their annual review for type 2 diabetes. Diabetes Care. 2019;42(6):1132‐1135.
Matthews A, Herrett E, Gasparrini A, et al. Impact of statin related media coverage on use of statins: interrupted time series analysis with UK primary care data. BMJ. 2016;353:i3283.
Nieuwlaat R, Wilczynski N, Navarro T, et al. Interventions for enhancing medication adherence. Cochrane Database Syst Rev. 2014;11:CD000011. doi:10.1002/14651858.CD000011.pub4
Gupta AK, Arshad S, Poulter NR. Compliance, safety, and effectiveness of fixed‐dose combinations of antihypertensive agents. Hypertension. 2010;55(2):399‐407.
Ge L, Heng BH, Yap CW. Understanding reasons and determinants of medication non‐adherence in community‐dwelling adults: a cross‐sectional study comparing young and older age groups. BMC Health Serv Res. 2023;23(1):905.
Fernandez‐Lazaro CI, García‐González JM, Adams DP, et al. Adherence to treatment and related factors among patients with chronic conditions in primary care: a cross‐sectional study. BMC Fam Pract. 2019;20(1):132.
Degli Esposti L, Saragoni S, Benemei S, et al. Adherence to antihypertensive medications and health outcomes among newly treated hypertensive patients. Clinicoecon Outcomes Res. 2011;3:47‐54.
Kim SJ, Kwon OD, Han EB, et al. Impact of number of medications and age on adherence to antihypertensive medications: a nationwide population‐based study. Medicine (Baltimore). 2019;98(49):e17825.
Vervloet M, Korevaar JC, Leemrijse CJ, Paget J, Zullig LL, van Dijk L. Interventions to improve adherence to cardiovascular medication: what about gender differences? A systematic literature review. Patient Prefer Adherence. 2020;14:2055‐2070.
Lewey J, Shrank WH, Bowry AD, Kilabuk E, Brennan TA, Choudhry NK. Gender and racial disparities in adherence to statin therapy: a meta‐analysis. Am Heart J. 2013;165(5):665‐678.e1.
Venditti V, Bleve E, Morano S, Filardi T. Gender‐related factors in medication adherence for metabolic and cardiovascular health. Metabolites. 2023;13(10):1087. doi:10.3390/metabo13101087
Mazzitelli M, Scaglione V, Cozzolino C, et al. Achievement of primary prevention cardiometabolic targets in women with HIV: an urgent call to action to pursue cardiovascular health. Viruses. 2024;16(4):578.