Adherence Rates of Antibiotic Use During Antiretroviral Therapy in People Living with HIV/AIDS

Objective: To determine frequency of antibiotic use and medication adherence to antibiotics used for opportunistic infections (OI) in people living with HIV/AIDS (PLWHA) who are taking anti-retroviral therapy (ART). Methods: This retrospective review was conducted as a part of a larger study examining communication patterns between pharmacists and PLWHA using medication refill data obtained from community pharmacies between June 2014 to September 2015. Medication refill history, which included initial research participation date, prescription fill history, and day supply were collected. Patients were included in this study if they were aged 25 years or older, infected with HIV and received both ART and antibiotic therapy for 6 months or longer. To distinguish OI and non-OI antibiotic regimens, medications were classified according to the Guidelines for Prevention and Treatment of Opportunistic Infections in HIV-Infected Adults and Adolescents from the U.S. Department of Health & Human Services. The adherence rates of ART and OI antibiotics was determined using standard metrics of proportion of days covered (PDC), or the number of days that a patient has had a medication for a specific period of time. Satisfactory PDC value for adherence is ≥ 95%. Results: A total of 155 patients were included in this study with a mean age of 48.8 years (range 25-73). The total proportion of males was 66.9% (n=101). Overall, 72 (46.5%) participants were taking antibiotics for OI, 106 (68.4%) subjects were taking antibiotics for non-OI infections, and 25 (16.1%) subjects were taking both therapies. More males were using OI antibiotics than females (p=0.021). There was no difference between genders with respect to non-OI antibiotic use (p=0.239). The most common antibiotic for OI was sulfamethoxazole/trimethoprim and the most common non-OI antibiotic was doxycycline. The mean PDC for ART and antibiotics for OI are 93.5% and 88.1%, respectively. Conclusions: Antibiotic use is common for opportunistic infections and short term infections in PLWHA. Adherence to both ART and antibiotics for opportunistic infections was good overall, but less than ideal. Future interventions should be targeted at increasing adherence to ART and OI antibiotic therapies.