Abstract
BackgroundWhile the relationship between average adherence to HIV potent antiretroviral therapy is well defined, the relationship between patterns of adherence within adherence strata has not been investigated. We examined medication event monitoring system (MEMS) defined adherence patterns and their relation to subsequent virologic rebound.Methods and ResultsWe selected subjects with at least 3-months of previous virologic suppression on a non-nucleoside reverse transcriptase inhibitor (NNRTI)-based regimen from two prospective cohorts in France and North America. We assessed the risk of virologic rebound, defined as HIV RNA of >400 copies/mL according to several MEMS adherence measurements.Seventy two subjects were studied, five of them experienced virologic rebound. Subjects with and without virologic rebound had similar baseline characteristics including treatment durations, regimen (efavirenz vs nevirapine), and dosing schedule. Each 10% increase in average adherence decreased the risk of virologic rebound (OR = 0.56; 95% confidence interval (CI) [0.37, 0.81], P<0.002). Each additional consecutive day off therapy for the longest treatment interruption (OR = 1.34; 95%CI [1.15, 1.68], P<0.0001) and each additional treatment interruption for more than 2 days (OR = 1.38; 95%CI [1.13, 1.77], P<0.002) increased the risk of virologic rebound. In those with low-to-moderate adherence (i.e. <80%), treatment interruption duration (16.2 days versus 6.1 days in the control group, P<0.02), but not average adherence (53.1% vs 55.9%, respectively, P = 0.65) was significantly associated with virologic rebound.ConclusionsSustained treatment interruption may pose a greater risk of virologic rebound on NNRTI therapy than the same number of interspersed missed doses at low-to-moderate adherence.
Highlights
Adherence to HIV antiretroviral therapy is the strongest predictor of virologic suppression[1,2], HIV drug resistance[3], disease progression and death[4,5]
Sustained treatment interruption may pose a greater risk of virologic rebound on nonnucleoside reverse transcriptase inhibitors (NNRTI) therapy than the same number of interspersed missed doses at low-to-moderate adherence
While treatment with unboosted protease inhibitors (PI) requires near perfect adherence for virologic suppression[1], the introduction of more potent nonnucleoside reverse transcriptase inhibitors (NNRTI) and ritonavir boosted PI therapy has lead to reliable virologic suppression at moderate levels of adherence for most, but not all patients[6,7,8,9]
Summary
Adherence to HIV antiretroviral therapy is the strongest predictor of virologic suppression[1,2], HIV drug resistance[3], disease progression and death[4,5]. While treatment with unboosted protease inhibitors (PI) requires near perfect adherence for virologic suppression[1], the introduction of more potent nonnucleoside reverse transcriptase inhibitors (NNRTI) and ritonavir boosted PI therapy has lead to reliable virologic suppression at moderate levels of adherence for most, but not all patients[6,7,8,9]. Because the NNRTIs are potent and have a very long-half life in vivo, we hypothesized that once viral suppression was achieved, a sustained treatment interruption rather than frequent missed doses would be associated with virologic failure. While the relationship between average adherence to HIV potent antiretroviral therapy is well defined, the relationship between patterns of adherence within adherence strata has not been investigated. We examined medication event monitoring system (MEMS) defined adherence patterns and their relation to subsequent virologic rebound
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Free) 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a call
