title: No evidence of an association between transient HIV viremia ("Blips") and lower adherence to the antiretroviral medication regimen.
abstract: BACKGROUND
  Transient human immunodeficiency virus (HIV) viremia, a common phenomenon among patients taking antiretroviral therapy, is often attributed to lapses in adherence to the medication regimen. We investigated this relationship in a prospective observational cohort of 128 patients initiating a new regimen.
  
  
  METHODS
  A case of transient viremia was defined as an HIV RNA level of 40-1000 copies/mL ("blip") sandwiched between 2 months of HIV RNA levels <40 copies/mL ("pre" and "post"). Adherence was most often measured with a composite adherence score (CAS), which is primarily based on electronically measured adherence. Case subjects' adherence and dose-timing was compared with (1) that of other patients (control subjects), who had undetectable virus loads for 3 consecutive months, and (2) that during periods of sustained undetectable virus loads among the case subjects themselves, if available.
  
  
  RESULTS
  Among the 28 case subjects, mean CAS-measured adherence did not decrease before transient viremia; adherence during the pre, blip, and post periods were 86%, 84%, and 80%, respectively. Control subjects had lower adherence levels during the corresponding 3 months (77%, 79%, and 75%, respectively; P = .046). Among the 19 patients able to serve as their own controls, CAS-measured adherence was higher during the period of transient viremia than during control periods (P = .01). Similar relationships were found when comparing only electronically measured adherence on a week-wise basis. There were no significant differences in dose-timing error between case subjects and control subjects.
  
  
  CONCLUSIONS
  We found no evidence that transient HIV viremia is associated with decreases in adherence or differences in dose-timing. Other etiologies for transient viremia should be evaluated.
authors.affiliation: Division of Infectious Diseases, Harbor-UCLA Medical Center, and Harbor-UCLA Research and Education Institute, and UCLA AIDS Institute Center for AIDS Research, University of California Los Angeles, Los Angeles, California, USA. lgmiller@ucla.edu
authors.forename: Loren G
authors.initials: LG
authors.lastname: Miller
authors.forename: Carol E
authors.initials: CE
authors.lastname: Golin
authors.forename: Honghu
authors.initials: H
authors.lastname: Liu
authors.forename: Ron D
authors.initials: RD
authors.lastname: Hays
authors.forename: Jenna
authors.initials: J
authors.lastname: Hua
authors.forename: Neil S
authors.initials: NS
authors.lastname: Wenger
authors.forename: Andrew H
authors.initials: AH
authors.lastname: Kaplan
mesh_terms: D000328:Adult; D019380:Anti-HIV Agents / Q000008:administration & dosage*; D016022:Case-Control Studies; D015331:Cohort Studies; D004359:Drug Therapy, Combination; D005260:Female; D015658:HIV Infections / Q000188:drug therapy* / Q000276:immunology* / Q000821:virology*; D015497:HIV-1 / Q000254:growth & development* / Q000276:immunology; D006801:Humans; D008297:Male; D008875:Middle Aged; D010349:Patient Compliance; D011446:Prospective Studies; D019562:Viral Load; D014766:Viremia / Q000188:drug therapy / Q000821:virology*
chemical_list: D019380:Anti-HIV Agents