Cardiovascular medication adherence testing in patients living with HIV: A single-centre observational study

Joshua Nazareth; Ayobami Adebayo; Muhammad Fahad; Hanfa Karim; Daniel Pan; Shirley Sze; Christopher A Martin; Jatinder S Minhas; Dennis Bernieh; Hanad Osman; Phayre Elverstone; Iain Stephenson; Pankaj Gupta; Manish Pareek

doi:10.1111/hiv.13715

Cardiovascular medication adherence testing in patients living with HIV: A single-centre observational study

HIV Med. 2024 Sep 24. doi: 10.1111/hiv.13715. Online ahead of print.

Authors

Joshua Nazareth^{1

2

3

4}, Ayobami Adebayo¹, Muhammad Fahad¹, Hanfa Karim¹, Daniel Pan^{1

2

3

4

5

6}, Shirley Sze^{3

7}, Christopher A Martin^{1

2

3

4}, Jatinder S Minhas^{3

7

8}, Dennis Bernieh^{7

9}, Hanad Osman^{7

9

10}, Phayre Elverstone¹, Iain Stephenson¹, Pankaj Gupta^{3

7

9

11}, Manish Pareek^{1

2

3

4

11}

Affiliations

¹ Department of Infection and HIV Medicine, University Hospitals of Leicester NHS Trust, Leicester, UK.
² Department of Respiratory Sciences, University of Leicester, Leicester, UK.
³ Leicester NIHR Biomedical Research Centre, Leicester, UK.
⁴ Development Centre for Population Health, University of Leicester, Leicester, UK.
⁵ Li Ka Shing Centre for Health Information and Discovery, Oxford Big Data Institute, University of Oxford, Oxford, UK.
⁶ WHO Collaborating Centre for Infectious Disease Epidemiology and Control, School of Public Health, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong, China.
⁷ Department of Cardiovascular Sciences, University of Leicester, Leicester, UK.
⁸ Cerebral Haemodynamics in Ageing and Stroke Medicine (CHiASM) Research Group, Department of Cardiovascular Sciences, University of Leicester, Leicester, UK.
⁹ Department of Metabolic Diseases and Chemical Pathology, University Hospitals of Leicester NHS Trust, Leicester, UK.
¹⁰ Diabetes Research Centre, Department of Population Health Sciences, University of Leicester, Leicester, UK.
¹¹ NIHR Applied Research Collaboration, Leicester General Hospital, Leicester, UK.

PMID: 39315489
DOI: 10.1111/hiv.13715

Abstract

Introduction: 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.

Methods: 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.

Results: 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].

Conclusion: 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.

Keywords: HIV; adherence; cardiovascular disease; comorbidity; statins.

Abstract

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