Achieving plasma HIV RNA below the level of detection in clinical practice

Clinical trials have shown that highly active antiretroviral therapy (HAART) reduces plasma HIV RNA below the detection level in up to 90 per cent of patients. To assess the independent predictors that are associated with achieving undetectable plasma HIV RNA in the daily clinical practice, we carried out a retrospective study. Among 106 HIV-infected patients treated with HAART, 63 (59 per cent) achieved undetectable plasma HIV RNA (less than 400 copies/ml) at their last visit. Adherence with HAART (greater than 80 per cent of prescribed dose) was self-reported by 81 patients (76 per cent). Independent predictors of achieving undetectable plasma HIV RNA were: self-reported adherence to therapy (Odds ratio [OR] 11.79, 95 per cent Confidence intervals [CI]: 3.55-33.17, p = 0.0001) and lack of previous antiretroviral therapy (OR: 3.12, 95 per cent CI: 1.09-8.96, p = 0.03). The efficacy of antiretroviral therapy observed in the daily clinical practice was noticeably lower than that reported in clinical trials. Patient adherence with prescribed HAART and lack of previous antiretroviral therapy are important factors related to successful therapy in the real world.