title: Impact of adherence on duration of virological suppression among patients receiving combination antiretroviral therapy.
abstract: OBJECTIVE
  To assess the effect of adherence to antiretroviral therapy on the duration of virological suppression after controlling for whether or not the patient ever attained a plasma viral load below the limit of detection of sensitive HIV-1 RNA assays.
  
  
  METHODS
  Data were combined from three randomized, blinded clinical trials (INCAS, AVANTI-2, and AVANTI-3) that compared the antiviral effects of two- and three-drug antiretroviral regimens. Virological suppression was defined as maintaining a plasma viral load below 1000 copies/mL. Adherence was defined prospectively and measured by patient self-report.
  
  
  RESULTS
  Adherence did not have a major impact on the probability of achieving virological suppression for patients receiving dual therapy. However, for patients receiving triple therapy, adherence increased the probability of virological suppression, whether the plasma viral load nadir was above or below the lower limit of quantification. Compared to adherent patients with a plasma viral load nadir below the lower limit of quantification, the relative risk of virological failure was 3.0 for non-adherent patients with a nadir below the limit, 18.1 for adherent patients with a nadir above the limit, and 32.1 for non-adherent patients with a nadir above the limit.
  
  
  CONCLUSIONS
  For patients receiving current three-drug antiretroviral regimens, adherence to therapy and plasma viral load nadir are important factors determining the duration of virological suppression.
authors: Department of Public Health Sciences, University of Toronto, Toronto, Ontario, Canada.
authors: J M
authors: JM
authors: Raboud
authors: M
authors: M
authors: Harris
authors: S
authors: S
authors: Rae
authors: J S G
authors: JS
authors: Montaner
mesh_terms: D019380:Anti-HIV Agents / Q000008:administration & dosage / Q000627:therapeutic use*; D004359:Drug Therapy, Combination; D006801:Humans; D010349:Patient Compliance; D016032:Randomized Controlled Trials as Topic; D019562:Viral Load
chemical_list: D019380:Anti-HIV Agents