title: True durability: HIV virologic suppression in an urban clinic and implications for timing of intensive adherence efforts and viral load monitoring.
abstract: Although the majority of HIV-infected patients who begin potent antiretroviral therapy should expect long-term virologic suppression, the realities in practice are less certain. Durability of viral suppression was examined to define the best timing of targeted adherence strategies and intensive viral load monitoring in an urban clinic population with multiple challenges to ART adherence. We examined the risk of viral rebound for patients who achieved two consecutive viral loads lower than the lower limit of quantification (LLOQ) within 390 days. For 791 patients with two viral loads below the LLOQ, viral rebound >LLOQ from the first viral load was 36.9 % (95 % CI 32.2-41.6) in the first year, 26.9 % (95 % CI 21.7-32.1) in the year following one year of viral suppression, and 24.6 % (95 % CI 18.4-30.9) in the year following 2 years of viral suppression. However, for patients with CD4 ≥300 cells/µl who had 3-6 years of virologic suppression, the risk of viral rebound was very low. At the population level, the risk of viral rebound in a complex urban clinic population is surprisingly high even out to 3 years. Intensified monitoring and adherence efforts should target this high risk period. Thereafter, confidence in truly durable virologic suppression is improved.
authors.affiliation: Infectious Diseases Section, Medical Service, Veterans Affairs Medical Center, 50 Irving Street NW, VAMC, 151B, Washington, DC, 20422, USA, debra.benator@va.gov.
authors.forename: Debra A
authors.initials: DA
authors.lastname: Benator
authors.forename: Angelo
authors.initials: A
authors.lastname: Elmi
authors.forename: Manuel D
authors.initials: MD
authors.lastname: Rodriguez
authors.forename: Howard B
authors.initials: HB
authors.lastname: Gale
authors.forename: Virginia L
authors.initials: VL
authors.lastname: Kan
authors.forename: Heather J
authors.initials: HJ
authors.lastname: Hoffman
authors.forename: Susan
authors.initials: S
authors.lastname: Tramazzo
authors.forename: Karen
authors.initials: K
authors.lastname: Hall
authors.forename: Angela
authors.initials: A
authors.lastname: McKnight
authors.forename: Leah
authors.initials: L
authors.lastname: Squires
mesh_terms: D000554:Ambulatory Care Facilities; D023241:Antiretroviral Therapy, Highly Active; D018791:CD4 Lymphocyte Count; D015331:Cohort Studies; D005260:Female; D015658:HIV Infections / Q000097:blood / Q000188:drug therapy*; D015497:HIV-1 / Q000235:genetics; D006801:Humans; D008297:Male; D055118:Medication Adherence; D008875:Middle Aged; D017410:Practice Guidelines as Topic; D012367:RNA, Viral / Q000097:blood*; D012189:Retrospective Studies; D013997:Time Factors; D014505:Urban Population; D019562:Viral Load / Q000379:methods*
chemical_list: D012367:RNA, Viral