Abstract

Lower antiretroviral therapy (ART) adherence is associated with higher systemic inflammation in virally suppressed people with HIV (PWH); however, previous studies have mostly relied on subjective adherence measures and have not assessed this association by disease stage upon ART initiation. In the Monitoring Early Treatment Adherence study, adherence was monitored electronically in real time among adult, treatment-naïve PWH in Uganda and South Africa who initiated tenofovir disoproxil fumarate/emtricitabine/efavirenz during early-stage (CD4 >350 cells/µL) or late-stage (CD4 <200 cells/µL) disease. Participants who achieved viral suppression (<400 copies/mL) at 6months and remained suppressed after 12months were analysed. The association between average ART adherence and plasma concentrations of interleukin 6 (IL-6), soluble CD14 (sCD14) and D-dimer was evaluated using adjusted multivariable linear regression, stratified by disease stage. In all, 488 PWH (61% women, mean age 35years) were included in the analysis. Median ART adherence overall was 87%. In adjusted models, every 10% increase in average adherence was associated with a 3.0% decrease in IL-6 [95% confidence interval (CI): -5.9 to -0.01, p=0.05] at 12months. This relationship was observed in PWH with both early-stage (5.9%, 95% CI: -10.1 to -1.6, p=0.009) and late-stage disease (3.7%, 95% CI: -7.2 to -0.2, p=0.039). No significant associations were found with sCD14 or D-dimer. Objective ART adherence measurement was inversely associated with systemic inflammation in PWH who achieved viral suppression after ART initiation in sub-Saharan Africa, with a greater association in those with early-stage HIV. This finding underscores the importance of ART adherence beyond establishing viral suppression.

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