title: Level of adherence and HIV RNA suppression in the current era of highly active antiretroviral therapy (HAART).
abstract: The need to achieve ≥95 % adherence to HAART for treatment effectiveness may be a barrier for universal initiation at early stages of HIV. Using longitudinal data collected from 2006 to 2011 from cohort studies of MSM (MACS) and IDUs (ALIVE study), we estimated the minimum adherence needed to achieve HIV RNA suppression (<50 copies/mL), defined as the level at which at least 80 % were virally suppressed, and the odds of suppression was not significantly different than that observed with ≥95 % adherence. In the MACS, ≥80 % suppression was observed with 80-84 % adherence and the odds ratio for suppression (vs. ≥95 % adherence) was 1.43 (0.61, 3.33). In the ALIVE study where <35 % were on newer drugs, only 71.4 % were suppressed among those who reported ≥95 % adherence. Although IDUs on older HAART regimens may need to be ≥95 % adherent, concerns related to non-adherence may be less of a barrier to initiation of modern HAART regimens.
authors.affiliation: Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, 615 N Wolfe Street, E7646, Baltimore, MD, 21205, USA.
authors.forename: Shilpa
authors.initials: S
authors.lastname: Viswanathan
authors.forename: Roger
authors.initials: R
authors.lastname: Detels
authors.forename: Shruti H
authors.initials: SH
authors.lastname: Mehta
authors.forename: Bernard J C
authors.initials: BJ
authors.lastname: Macatangay
authors.forename: Gregory D
authors.initials: GD
authors.lastname: Kirk
authors.forename: Lisa P
authors.initials: LP
authors.lastname: Jacobson
mesh_terms: D000328:Adult; D023241:Antiretroviral Therapy, Highly Active; D001727:Bisexuality / Q000706:statistics & numerical data; D015331:Cohort Studies; D015897:Comorbidity; D055030:Drug Users / Q000706:statistics & numerical data; D005260:Female; D015658:HIV Infections / Q000188:drug therapy* / Q000453:epidemiology; D018451:Homosexuality, Male / Q000706:statistics & numerical data; D006801:Humans; D016014:Linear Models; D016015:Logistic Models; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D016017:Odds Ratio; D011446:Prospective Studies; D012367:RNA, Viral / Q000097:blood*; D015819:Substance Abuse, Intravenous / Q000453:epidemiology; D016896:Treatment Outcome; D019562:Viral Load; D016903:Drug Monitoring
chemical_list: D012367:RNA, Viral