Abstract
BackgroundDespite the effectiveness of prophylaxis, Pneumocystis jirovecii pneumonia (PCP) continues to be the most common serious opportunistic infection among HIV-infected persons. We describe factors associated with nonadherence to primary PCP prophylaxis.Methodology/Principal FindingsWe used 2000–2004 data from the Supplement to HIV/AIDS Surveillance (SHAS) project, a cross-sectional interview project of HIV-infected persons ≥18 years conducted in 18 states. We limited the analysis to persons who denied having prior PCP, reported having a current prescription to prevent PCP, and answered the question “In the past 30 days, how often were you able to take the PCP medication(s) exactly the way your doctor told you to take them?” We used multivariable logistic regression to describe factors associated with nonadherence. Of 1,666 subjects prescribed PCP prophylaxis, 305 (18.3%) were nonadherent. Persons were more likely to be nonadherent if they reported using marijuana (adjusted odds ratio [aOR] = 1.6, 95% confidence interval [CI] = 1.1–2.4), non-injection drugs other than marijuana (aOR = 1.5, 95% CI = 1.0–2.1), or injection drugs (aOR = 2.3, 95% CI = 1.3–4.1) in the past year; their mental health was “not good” for ≥1 day during the past month (aOR = 1.6, 95% CI = 1.2–2.2); their most recent CD4 count was <200 cells/μL (aOR = 1.6, 95% CI = 1.1–2.2); or taking ART usually (aOR = 9.6, 95% CI = 6.7–13.7) or sometimes/rarely/never (aOR = 18.4, 95% CI = 11.1–30.4), compared with always, as prescribed.Conclusion/SignificanceProviders should inquire about and promote strategies to improve adherence to PCP prophylaxis, particularly among persons who use illicit drugs, have mental health issues, and who are not compliant with ART to reduce the occurrence of PCP.
Highlights
Pneumocystis jirovecii pneumonia (PCP) continues to be the most common serious opportunistic infection occurring among persons with HIV infection in the United States despite effective prophylactic therapy [1]
Of the 11,503 persons asked to participate in Supplement to HIV/AIDS Surveillance (SHAS), 1,666 (18.3% of interviewed) respondents who had a prescription for primary PCP prophylaxis and complete information about adherence to PCP prophylaxis were included in the analysis
Nonadherence to primary PCP prophylaxis was associated with year of SHAS interview, illicit drug use in the past year, current risk for alcohol abuse, description of mental health as ‘‘not good’’ for $1 day in the past month, most recent CD4 count,200 cells/mL, most recent HIV viral load .5,000 copies/mL, and nonadherence to antiretroviral therapy (ART) in the past month (Table 1)
Summary
Pneumocystis jirovecii pneumonia (PCP) continues to be the most common serious opportunistic infection occurring among persons with HIV infection in the United States despite effective prophylactic therapy [1]. Prophylaxis against PCP is effective, the benefits can only be realized if HIV-positive persons access healthcare, providers appropriately prescribe prophylaxis to persons at risk for PCP, and patients adhere to prescribed PCP prophylaxis. The proportion of eligible persons prescribed PCP prophylaxis in a large U.S cohort of HIV-positive persons was 80% [9], whereas in another study, the proportion of providers who adhered with guidelines for prescribing PCP prophylaxis in federally funded HIV treatment facilities ranged from 80–94% [10]. Despite the effectiveness of prophylaxis, Pneumocystis jirovecii pneumonia (PCP) continues to be the most common serious opportunistic infection among HIV-infected persons. We describe factors associated with nonadherence to primary PCP prophylaxis
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