Apparent Antiretroviral Over-Adherence by Pill Count is Associated with HIV Treatment Failure in Adolescents

Pill counts with calculated adherence percentages are used in many settings to monitor adherence, but can be undermined by patients discarding pills to hide non-adherence. 

Pill counts suggesting that >100% of prescribed doses were taken can signal "pill dumping." We defined "over-adherence" (OA) among a cohort of 300 HIV-infected adolescents as having >1/3 of pill counts with >100% adherence during a year of follow-up. Apparent over-adherence was more common in those with virologic failure than those with suppressed viral loads (33% vs 13%, chi p=0.001). 

Pill count adherence repeatedly >100% may identify HIV-infected adolescents at increased risk of treatment failure.

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By:  Okatch H1, Beiter K, Eby J, Chapman J, Marukutira T, Tshume O, Matshaba M, Anabwani GM, Gross R, Lowenthal E.

• 1Children's Hospital of Philadelphia, Philadelphia, PA, USA 
• 2 University of Pennsylvania Perelman School of Medicine, Masters of Public Health Program, Philadelphia, PA, USA 
• 3 University of Botswana, Gaborone, Botswana 
• 4 Botswana-Baylor Children's Clinical Centre of Excellence, Gaborone, Botswana 
• 5 Baylor College of Medicine, Department of Pediatrics, Section of Retrovirology, Houston, TX, USA 
• 6 University of Pennsylvania Perelman School of Medicine, Departments of Medicine and Epidemiology, Philadelphia, PA, USA 
• 7 University of Pennsylvania Perelman School of Medicine, Departments of Pediatrics and Epidemiology, Philadelphia, PA, USA.
• J Acquir Immune Defic Syndr. 2016 Mar 16 

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