HIV-infected patients receiving lopinavir/ritonavir-based antiretroviral therapy achieve high rates of virologic suppression despite adherence rates less than 95%.
BACKGROUND
The observation that extremely high levels of medication adherence are required to achieve complete virologic suppression is based largely on studies of treatment-experienced patients receiving HIV protease inhibitor (PI)-based therapy without ritonavir boosting. This study aims to define the level of adherence needed to achieve virologic suppression in patients receiving boosted PI-based highly active antiretroviral therapy (HAART) with lopinavir/ritonavir.


METHODS
HIV-infected adults receiving a regimen containing lopinavir/ritonavir were recruited into a prospective, observational study of the relation between adherence to lopinavir/ritonavir and virologic outcomes. Adherence was measured using the Medication Event Monitoring System (MEMS; Aardex, Union City, CA). HIV-1 viral load (VL) was measured at week 24.


RESULTS
The final study population contained 64 subjects. Eighty percent had AIDS, 97% received lopinavir/ritonavir before enrollment, and most had more than 7 years of HAART experience. Mean adherence overall was 73%. Eighty percent and 59% achieved a VL <400 copies/mL and a VL <75 copies/mL, respectively. Mean adherence was 75% in those achieving a VL <75 copies/mL. High rates of virologic suppression were observed in all adherence quartiles, including the lowest quartile (range of adherence: 23.5%-53.3%).


CONCLUSIONS
Moderate levels of adherence can lead to virologic suppression in most patients taking lopinavir/ritonavir-based HAART.
Shuter
Jonathan
J
AIDS Center and Division of Infectious Diseases, Montefiore Medical Center, Bronx, NY 10467, USA. jshuter@montefiore.org
Sarlo
Julie A
JA
Kanmaz
Tina J
TJ
Rode
Richard A
RA
Zingman
Barry S
BS
D000328:Adult; D023241:Antiretroviral Therapy, Highly Active; D044383:Black People / Q000706:statistics & numerical data; D018791:CD4 Lymphocyte Count; D004359:Drug Therapy, Combination; D005260:Female; D015658:HIV Infections / Q000188:drug therapy* / Q000276:immunology / Q000821:virology; D017320:HIV Protease Inhibitors / Q000627:therapeutic use*; D015497:HIV-1; D006630:Hispanic or Latino / Q000706:statistics & numerical data; D006801:Humans; D061466:Lopinavir; D008297:Male; D008875:Middle Aged; D010349:Patient Compliance; D011744:Pyrimidinones / Q000627:therapeutic use*; D012189:Retrospective Studies; D019438:Ritonavir / Q000627:therapeutic use*; D013997:Time Factors; D016896:Treatment Outcome; D019562:Viral Load; D044465:White People / Q000706:statistics & numerical data
D017320:HIV Protease Inhibitors; D011744:Pyrimidinones; D061466:Lopinavir; D019438:Ritonavir