Antiretroviral Adherence Level Necessary for HIV Viral Suppression Using Real-World Data

Datos Bibliográficos

ID23364113
AutoresKathy K Byrd (0000-0002-9818-5634, Centers for Disease Control and Prevention, autor de correspondencia), John Hou (Walgreens (United States)), John G Hou (Health Analytics, Research, and Reporting Department, Walgreen Co., Deerfield, IL), Ron Hazen (Walgreens (United States)), Heather Kirkham (0000-0003-1247-1005, Walgreens (United States)), Sumihiro Suzuki (0000-0002-6408-9580, University of North Texas), Patrick G Clay (0000-0001-8892-3077, University of North Texas), Tim Bush (Centers for Disease Control and Prevention), Nasima M Camp (0000-0003-2037-0300, ICF International (United States)), Paul J Weidle (Centers for Disease Control and Prevention), Ambrose Delpino (Walgreens (United States)), for the Patient-Centered HIV Care Model Team
Año2019
Volumen82
Número3
Páginas245-251
Fecha de publicación2019-11-01
Peer ReviewedSí
Open AccessNo
TipoARTICLE
RevistaJAIDS Journal of Acquired Immune Deficiency Syndromes (JOURNAL)
Identificadores de la revistaISSN: 1525-4135 • E-ISSN: 1944-7884
EditorialOvid Technologies (Wolters Kluwer Health) (PUBLISHER)
DOI10.1097/qai.0000000000002142
PMID31343455
OpenAlexW2962926112
IdiomaEN
Citas recibidas62
Referencias citadas29

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.

Antiretroviral therapy · Antiretroviral treatment · Human immunodeficiency virus (HIV) · Viral load · HIV Research and Treatment · HIV/AIDS drug development and treatment · HIV/AIDS Research and Interventions · Medicine · Virology