Antiretroviral Adherence Level Necessary for HIV Viral Suppression Using Real-World Data
Top Cited Papers
- 1 November 2019
- journal article
- research article
- Published by Ovid Technologies (Wolters Kluwer Health) in JAIDS Journal of Acquired Immune Deficiency Syndromes
- Vol. 82 (3), 245-251
- https://doi.org/10.1097/qai.0000000000002142
Abstract
Background: A benchmark of near-perfect adherence (≥95%) to antiretroviral therapy (ART) is often cited as necessary for HIV viral suppression. However, given newer, more effective ART medications, the threshold for viral suppression may be lower. We estimated the minimum ART adherence level necessary to achieve viral suppression. Settings: The Patient-centered HIV Care Model demonstration project. Methods: Adherence to ART was calculated using the proportion of days covered measure for the 365-day period before each viral load test result, and grouped into 5 categories (<50%, 50% to <80%, 80% to <85%, 85% to <90%, and ≥90%). Binomial regression analyses were conducted to determine factors associated with viral suppression (HIV RNA <200 copies/mL); demographics, proportion of days covered category, and ART regimen type were explanatory variables. Generalized estimating equations with an exchangeable working correlation matrix accounted for correlation within subjects. In addition, probit regression models were used to estimate adherence levels required to achieve viral suppression in 90% of HIV viral load tests. Results: The adjusted odds of viral suppression did not differ between persons with an adherence level of 80% to <85% or 85% to <90% and those with an adherence level of ≥90%. In addition, the overall estimated adherence level necessary to achieve viral suppression in 90% of viral load tests was 82% and varied by regimen type; integrase inhibitor- and nonnucleoside reverse transcriptase inhibitor-based regimens achieved 90% viral suppression with adherence levels of 75% and 78%, respectively. Conclusions: The ART adherence level necessary to reach HIV viral suppression may be lower than previously thought and may be regimen-dependent.Keywords
This publication has 31 references indexed in Scilit:
- Closing the Gap: Increases in Life Expectancy among Treated HIV-Positive Individuals in the United States and CanadaPLOS ONE, 2013
- Adherence as a Predictor of the Development of Class-Specific Resistance Mutations: The Swiss HIV Cohort StudyPLOS ONE, 2013
- Levels of Adherence Required for Virologic Suppression Among Newer Antiretroviral MedicationsAnnals of Pharmacotherapy, 2011
- The Risk of Virologic Failure Decreases with Duration of HIV Suppression, at Greater than 50% Adherence to Antiretroviral TherapyPLOS ONE, 2009
- New antiretroviral drugs: a review of the efficacy, safety, pharmacokinetics, and resistance profile of tipranavir, darunavir, etravirine, rilpivirine, maraviroc, and raltegravirExpert Opinion on Pharmacotherapy, 2009
- Relationship between Adherence Level, Type of the Antiretroviral Regimen, and Plasma HIV Type 1 RNA Viral Load: A Prospective Cohort StudyAIDS Research and Human Retroviruses, 2008
- Effect of Adherence to HAART on Virologic Outcome and on the Selection of Resistance-Conferring Mutations in NNRTI- or PI-Treated PatientsHIV Research & Clinical Practice, 2007
- Adherence–resistance relationships for protease and non-nucleoside reverse transcriptase inhibitors explained by virological fitnessAIDS, 2006
- Impact of active drug use on antiretroviral therapy adherence and viral suppression in HIV-infected drug usersJournal of General Internal Medicine, 2002
- Impact of Active Drug Use on Antiretroviral Therapy Adherence and Viral Suppression in HIV-infected Drug UsersJournal of General Internal Medicine, 2002