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Antiretroviral Adherence Level Necessary for HIV Viral Suppression Using Real-World Data
Kathy K Byrd1, John G Hou2, Ron Hazen2
1Division of HIV/AIDS Prevention, Centers for Disease Control and Prevention, Atlanta, GA.
Journal of Acquired Immune Deficiency Syndromes (1999)
|July 26, 2019
Summary
Newer HIV medications may lower the required antiretroviral therapy (ART) adherence for viral suppression. Studies suggest that adherence levels between 80-90% may be sufficient, depending on the ART regimen.
Area of Science:
- Infectious Diseases
- Virology
- Pharmacology
Background:
- The traditional benchmark for effective antiretroviral therapy (ART) in HIV management requires near-perfect adherence (≥95%).
- Advancements in ART have led to more potent medications, prompting re-evaluation of the necessary adherence threshold for achieving viral suppression.
- This study aimed to determine the minimum ART adherence level required for successful viral suppression in individuals with HIV.
Purpose of the Study:
- To estimate the minimum level of adherence to antiretroviral therapy (ART) necessary for achieving viral suppression in people with HIV.
- To investigate whether the adherence threshold for viral suppression differs based on the type of ART regimen used.
Main Methods:
- Adherence to ART was measured using the proportion of days covered (PDC) over a 365-day period preceding viral load tests.
- Participants' adherence data were categorized into five groups: <50%, 50% to <80%, 80% to <85%, 85% to <90%, and ≥90%.
- Binomial regression and generalized estimating equations were employed to analyze factors associated with viral suppression (HIV RNA <200 copies/mL), including adherence levels and ART regimen type. Probit regression models estimated the adherence levels needed for 90% viral suppression.
Main Results:
- Viral suppression rates did not significantly differ between adherence levels of 80% to <85%, 85% to <90%, and ≥90%.
- The overall estimated adherence level required to achieve 90% viral suppression was 82%.
- Specific ART regimens demonstrated varying adherence thresholds: integrase inhibitor-based regimens required 75% adherence, and nonnucleoside reverse transcriptase inhibitor-based regimens required 78% adherence for 90% viral suppression.
Conclusions:
- The minimum ART adherence level needed for HIV viral suppression may be lower than the previously established 95% benchmark.
- Adherence thresholds for achieving viral suppression are regimen-dependent, with newer ARTs potentially requiring lower adherence.
- These findings highlight the importance of personalized adherence targets based on individual ART regimens to optimize HIV treatment outcomes.
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