Highly specific reasons for nonadherence to antiretroviral therapy: Results from the German adherence study

Johanna Boretzki, Eva Wolf, Carmen Wiese, Sebastian Noe, Annamaria Balogh, Anja Meurer, Ivanka Krznaric, Alexander Zink, Christian Lersch, Christoph D. Spinner

Research output: Contribution to journalArticlepeer-review

19 Scopus citations


Background: Reasons for and frequency of nonadherence to antiretroviral therapy (ART) may have changed due to pharmacological improvements. In addition, the importance of known non-pharmacologic reasons for nonadherence is unclear. Methods: We performed a cross-sectional, noninterventional, multicenter study to identify current reasons for nonadherence. Patients were categorized by physicians into the following adherence groups: good, unstable, or poor adherence. Co-variables of interest included age, sex, time since HIV diagnosis, ART duration, current ART regimen, HIV transmission route, comorbidity, HIV-1 RNA viral load (VL), and CD4 cell count. Patients self-reported the number of missed doses and provided their specific reasons for nonadherent behavior. Statistical analyses were performed using Fisher’s extended exact test, Kruskal-Wallis test, and logistic regression models. Results: Our study assessed 215 participants with good (n=162), unstable (n=36), and poor adherence (n=17). Compared to patients with good adherence, patients with unstable and poor adherence reported more often to have missed at least one dose during the last week (good 11% vs unstable 47% vs poor 63%, p<0.001). Physicians’ adherence assessment was concordant with patients’ self-reports of missed doses during the last week (no vs one or more) in 81% cases. Similarly, we found a strong association of physicians’ assessment with viral suppression. Logistic regression analysis showed that “reduced adherence” - defined as unstable or poor - was significantly associated with patients <30 years old, intravenous drug use, history of acquired immune deficiency syndrome (AIDS), and psychiatric disorders (p<0.05). Univariate analyses showed that specific reasons, such as questioning the efficacy/dosing of ART, HIV stigma, interactive toxicity beliefs regarding alcohol and/or party drugs, and dissatisfaction with regimen complexity, correlated with unstable or poor adherence (p<0.05). Conclusion: Identification of factors associated with poor adherence helps in identifying patients with a higher risk for nonadherence. Reasons for nonadherence should be directly addressed in every patient, because they are common and constitute possible adherence intervention points.

Original languageEnglish
Pages (from-to)1897-1906
Number of pages10
JournalPatient Preference and Adherence
StatePublished - 8 Nov 2017
Externally publishedYes


  • ART
  • Adherence
  • Antiretroviral therapy
  • HIV
  • Human immunodeficiency virus
  • Nonadherence
  • Patients’ beliefs


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