title: Higher rates of viral suppression with nonnucleoside reverse transcriptase inhibitors compared to single protease inhibitors are not explained by better adherence.
abstract: BACKGROUND
  Although evidence suggests that antiretroviral (ARV) regimens containing nonnucleoside reverse transcriptase inhibitors (NNRTIs) are superior to single-protease inhibitor (PI)-based regimens at suppressing viral load, it is unclear how much of the improved viral suppression is due to intrinsic drug potency versus higher levels of adherence to simpler regimens. We therefore examined adherence and viral suppression in NNRTI and single-PI regimens in a cohort of largely ARV-experienced participants by using objective measures of adherence.
  
  
  METHODS
  Participants were recruited from the Research on Access to Care in the Homeless (REACH) Cohort and were included in the study if they were on single-PI-based or NNRTI-based highly active antiretroviral therapy (HAART) regimens for at least 3 months prior to study entry. Adherence was measured by unannounced pill counts at the participant's usual place of residence. The primary outcome was suppression of HIV viral RNA to <50 copies/mL.
  
  
  RESULTS
  Among 109 individuals who were followed for a median of 8.7 months, the odds of virologic suppression were approximately 8 times higher (p < .01) for participants on NNRTI-based regimens (n = 53) compared with those using single-PI-based regimens (n = 56) when controlling for adherence, as well as other potential confounders in a multivariable analysis. The only other independent predictors of viral suppression in multivariable modeling were ARV adherence (p < .01), CD4 nadir (p = .02), and continuous months on current regimen prior to the start of adherence monitoring (p < .01). There was no significant difference in adherence by unannounced pill counts in participants receiving NNRTI- versus single-PI-containing regimens.
  
  
  CONCLUSIONS
  A higher proportion of individuals using NNRTI-based regimens had viral suppression when compared to those taking single-PI-containing regimens, and this association was not confounded by higher levels of adherence. These results suggest that improved viral suppression on NNRTI regimens compared to single-PI regimens is more closely associated with regimen potency than higher levels of adherence.
authors.affiliation: Center for AIDS Prevention Studies, University of California-San Francisco (UCSF), San Francisco, CA 94143, USA. sweiser@itsa.ucsf.edu
authors.forename: Sheri D
authors.initials: SD
authors.lastname: Weiser
authors.forename: David
authors.initials: D
authors.lastname: Guzman
authors.forename: Elise D
authors.initials: ED
authors.lastname: Riley
authors.forename: Richard
authors.initials: R
authors.lastname: Clark
authors.forename: David R
authors.initials: DR
authors.lastname: Bangsberg
mesh_terms: D000328:Adult; D023241:Antiretroviral Therapy, Highly Active; D015331:Cohort Studies; D005260:Female; D015658:HIV Infections / Q000097:blood / Q000188:drug therapy*; D017320:HIV Protease Inhibitors / Q000008:administration & dosage*; D006703:Ill-Housed Persons / Q000706:statistics & numerical data; D006801:Humans; D008297:Male; D008875:Middle Aged; D010349:Patient Compliance / Q000706:statistics & numerical data*; D018894:Reverse Transcriptase Inhibitors / Q000008:administration & dosage*; D012495:San Francisco; D019562:Viral Load
chemical_list: D017320:HIV Protease Inhibitors; D018894:Reverse Transcriptase Inhibitors