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Level of Adherence and HIV RNA Suppression in the Current Era of Highly Active Antiretroviral Therapy (HAART)

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Abstract

The need to achieve ≥95 % adherence to HAART for treatment effectiveness may be a barrier for universal initiation at early stages of HIV. Using longitudinal data collected from 2006 to 2011 from cohort studies of MSM (MACS) and IDUs (ALIVE study), we estimated the minimum adherence needed to achieve HIV RNA suppression (<50 copies/mL), defined as the level at which at least 80 % were virally suppressed, and the odds of suppression was not significantly different than that observed with ≥95 % adherence. In the MACS, ≥80 % suppression was observed with 80–84 % adherence and the odds ratio for suppression (vs. ≥95 % adherence) was 1.43 (0.61, 3.33). In the ALIVE study where <35 % were on newer drugs, only 71.4 % were suppressed among those who reported ≥95 % adherence. Although IDUs on older HAART regimens may need to be ≥95 % adherent, concerns related to non-adherence may be less of a barrier to initiation of modern HAART regimens.

Resumen

En las primeras etapas del VIH, la necesidad de lograr ≥95 % de adherencia al TARGA para la efectividad del tratamiento puede ser una barrera para la iniciación universal. Utilizando datos longitudinales recogidos entre 2006 y 2011 de los estudios de cohorte de HSH (MACS) y UDI (estudio ALIVE), se estimó la adherencia mínima necesaria para lograr la supresión del ARN del VIH (<50 copies/mL), que se define como conseguir reducer la carga viral en al menos el 80 % de los sujetos y de tal forma que la probabilidad de supresión no sea significativamente diferente de la observada con ≥95 % de adherencia. En el MACS, ≥80 % de supresión se observó con la adhesión de 80-84 %, y el cociente de oportunidad para la supresión (vs. ≥95 % de adhesión) fue de 1.43 (0.61, 3.33). En el estudio ALIVE donde <35 % usaron las drogas más nuevas, sólo el 71.4 % fueron suprimidos entre los que reportaron ≥95 % de adherencia. Aunque los UDI en los regímenes TARGA mas anticuados pueden necesitar ser ≥95 % adherente, las preocupaciones relacionadas con la falta de adherencia no parece que debe ser considerada comouna barrera para la iniciación de los regímenes TARGA modernas.

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Acknowledgments

We would like to thank Multicenter AIDS Cohort Study (MACS) and AIDS Linked to the Intravenous Experience (ALIVE) study participants for their continued dedication. MACS centers (Principal Investigators) are at: Johns Hopkins University Bloomberg School of Public Health (Joseph Margolick), Northwestern University (Steven Wolinsky), University of California, Los Angeles (Roger Detels), University of Pittsburgh (Charles Rinaldo), and the Center for Analysis and Management of MACS, Johns Hopkins University Bloomberg School of Public Health (Lisa Jacobson). The MACS study is funded primarily by the National Institute of Allergy and Infectious Diseases (NIAID), with additional co-funding from the National Cancer Institute (NCI), National Heart, Lung, and Blood Institute (NHLBI), and the National Institute on Deafness and Communication Disorders (NIDCD): U01-AI35042, U01-AI35040, U01-AI35039, U01-AI35041, UM1-AI35043, and UL1-TR000424 (JHU CTSA). The ALIVE study is funded by the National Institute on Drug Abuse (NIDA), a part of the National Institutes of Health (NIH): DA04334 and DA12568.

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Authors and Affiliations

  1. Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, 615 N Wolfe Street, E7646, Baltimore, MD, 21205, USA

    Shilpa Viswanathan, Shruti H. Mehta, Gregory D. Kirk & Lisa P. Jacobson

  2. Department of Epidemiology, UCLA Fielding School of Public Health, Los Angeles, CA, USA

    Roger Detels

  3. Division of Infectious Diseases/HIV/AIDS Unit, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA

    Bernard J. C. Macatangay

  4. Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA

    Gregory D. Kirk

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  1. Shilpa Viswanathan
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  2. Roger Detels
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  6. Lisa P. Jacobson
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Correspondence to Lisa P. Jacobson.

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Viswanathan, S., Detels, R., Mehta, S.H. et al. Level of Adherence and HIV RNA Suppression in the Current Era of Highly Active Antiretroviral Therapy (HAART). AIDS Behav 19, 601–611 (2015). https://doi.org/10.1007/s10461-014-0927-4

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