title: Modeling the HIV protease inhibitor adherence-resistance curve by use of empirically derived estimates.
abstract: The standard view postulates a bell-shaped relationship between adherence to therapy and development of drug-resistant human immunodeficiency virus (HIV), with a resistance peak at a moderate level of adherence. This relationship has not been confirmed empirically. We statistically modeled the relationship between adherence and development of drug resistance, using empirically defined relationships of the rate of viral suppression and drug-resistance-mutation accumulation derived from patients receiving protease-inhibitor-based therapy. We found that the maximal rate of drug resistance occurs at 87% adherence and declines modestly at 100% adherence. Higher levels of viral suppression at 100% adherence (a marker of greater regimen potency) progressively reduce the overall population rate of drug resistance and shift the peak resistance rate to lower levels of adherence.
authors.affiliation: Epidemiology and Prevention Interventions Center, Division of Infectious Diseases, San Francisco General Hospital AIDS Program, University of California-San Francisco, 94110, USA. db@epi-center.ucsf.edu
authors.forename: David R
authors.initials: DR
authors.lastname: Bangsberg
authors.forename: Travis C
authors.initials: TC
authors.lastname: Porco
authors.forename: C
authors.initials: C
authors.lastname: Kagay
authors.forename: Edwin D
authors.initials: ED
authors.lastname: Charlebois
authors.forename: Steven G
authors.initials: SG
authors.lastname: Deeks
authors.forename: David
authors.initials: D
authors.lastname: Guzman
authors.forename: Richard
authors.initials: R
authors.lastname: Clark
authors.forename: Andrew
authors.initials: A
authors.lastname: Moss
mesh_terms: D000328:Adult; D024882:Drug Resistance, Viral; D005260:Female; D015658:HIV Infections / Q000188:drug therapy* / Q000821:virology; D017320:HIV Protease Inhibitors / Q000494:pharmacology / Q000627:therapeutic use*; D015497:HIV-1 / Q000187:drug effects; D006801:Humans; D008297:Male; D008875:Middle Aged; D008954:Models, Biological; D010349:Patient Compliance
chemical_list: D017320:HIV Protease Inhibitors