title: Durable Suppression of HIV-1 after Virologic Monitoring-Based Antiretroviral Adherence Counseling in Rakai, Uganda.
abstract: OBJECTIVE
  HIV viral load is recommended for monitoring antiretroviral treatment and identifying treatment failure. We assessed the durability of viral suppression after viral load-triggered adherence counseling among patients with HIV viremia 6 months after ART initiation.
  
  
  METHODS
  Observational cohort enrolled in an antiretroviral treatment program in rural Uganda.
  
  
  METHODS
  Participants who underwent routine viral load determination every 24 weeks and had at least 48 weeks of follow-up were included in this analysis. Patients with viral loads >400 copies/ml at 24 weeks of treatment were given additional adherence counseling, and all patients were followed to assess the duration of viral suppression and development of virologic failure.
  
  
  RESULTS
  1,841 participants initiating antiretroviral therapy were enrolled in the Rakai Health Sciences Program between June 2005 and June 2011 and were followed with viral load monitoring every 24 weeks. 148 (8%) of patients did not achieve viral suppression at 24 weeks and were given additional adherence counseling. 85 (60%) of these patients had undetectable viral loads at 48 weeks, with a median duration of viral suppression of 240 weeks (IQR 193-288 weeks). Failure to achieve an undetectable viral load at 48 weeks was associated with age <30 years and 24 week viral load >2,000 copies/ml in multivariate logistic regression analysis.
  
  
  CONCLUSIONS
  The majority of patients with persistent viremia who were provided adherence counseling achieved robust viral suppression for a median 4.6 years. Access to virologic monitoring and adherence counseling is a priority in resource-limited settings.
authors.affiliation: Johns Hopkins School of Medicine, Baltimore, Maryland; Rakai Health Sciences Program, Rakai, Uganda.
authors.forename: Alexander
authors.initials: A
authors.lastname: Billioux
authors.affiliation: Rakai Health Sciences Program, Rakai, Uganda.
authors.forename: Gertrude
authors.initials: G
authors.lastname: Nakigozi
authors.affiliation: Clinical Research Directorate/Clinical Monitoring Research Program, Leidos Biomedical Research, Inc., Frederick National Laboratory for Cancer Research, Frederick, Maryland.
authors.forename: Kevin
authors.initials: K
authors.lastname: Newell
authors.affiliation: Johns Hopkins School of Medicine, Baltimore, Maryland; Rakai Health Sciences Program, Rakai, Uganda; Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland.
authors.forename: Larry W
authors.initials: LW
authors.lastname: Chang
authors.affiliation: Johns Hopkins School of Medicine, Baltimore, Maryland; Rakai Health Sciences Program, Rakai, Uganda; National Institute for Allergy and Infectious Diseases, National Institutes of Health, Bethesda, Maryland.
authors.forename: Thomas C
authors.initials: TC
authors.lastname: Quinn
authors.affiliation: Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland.
authors.forename: Ron H
authors.initials: RH
authors.lastname: Gray
authors.affiliation: Rakai Health Sciences Program, Rakai, Uganda.
authors.forename: Anthony
authors.initials: A
authors.lastname: Ndyanabo
authors.affiliation: Rakai Health Sciences Program, Rakai, Uganda.
authors.forename: Ronald
authors.initials: R
authors.lastname: Galiwango
authors.affiliation: Rakai Health Sciences Program, Rakai, Uganda.
authors.forename: Valerian
authors.initials: V
authors.lastname: Kiggundu
authors.affiliation: Rakai Health Sciences Program, Rakai, Uganda; Makerere University College of Health Sciences, School of Public Health, Kampala, Uganda.
authors.forename: David
authors.initials: D
authors.lastname: Serwadda
authors.affiliation: Johns Hopkins School of Medicine, Baltimore, Maryland; Rakai Health Sciences Program, Rakai, Uganda; National Institute for Allergy and Infectious Diseases, National Institutes of Health, Bethesda, Maryland.
authors.forename: Steven J
authors.initials: SJ
authors.lastname: Reynolds
mesh_terms: D000328:Adult; D023241:Antiretroviral Therapy, Highly Active; D003376:Counseling; D005260:Female; D015658:HIV Infections / Q000188:drug therapy* / Q000821:virology*; D015497:HIV-1 / Q000502:physiology*; D006801:Humans; D008297:Male; D010349:Patient Compliance; D014454:Uganda; D019562:Viral Load / Q000502:physiology*