title: A simple self-reported adherence tool as a predictor of viral rebound in people with viral suppression on antiretroviral therapy.
abstract: OBJECTIVE
  The aim of the study was to investigate the relationship between self-reported antiretroviral therapy (ART) adherence and virological outcomes in the multinational Strategies for Management of Antiretroviral Therapy (SMART) study.
  
  
  METHODS
  Eligible participants were from the continuous ART arm and had at least one viral load (VL) ≤ 50 HIV-1 RNA copies/mL and a subsequent VL value (VL pair). Self-reported adherence was measured at each visit using a five-point Likert scale which employed a 7-day recall. High adherence was defined as taking 'all pills every day' (level 1) for every regimen component; all others had suboptimal adherence (levels 2 - 5). In individuals with VL suppression (≤ 50 copies/mL), the association between adherence (at the time of VL suppression) and VL rebound (> 200 copies/mL at next visit) was assessed using multivariable logistic regression with generalized estimating equations.
  
  
  RESULTS
  A total of 10 761 sets of VL pairs from 1986 participants were included in the study. For 1220 (11%) VL pairs, adherence was suboptimal. For 507 VL pairs (5%), VL rebound occurred. The risk of rebound generally increased as adherence decreased: 4.2% for level 1, 7.7% for level 2, 16.3% for level 3, 9.4% for level 4 and 12.9% for level 5. In multivariable analysis, suboptimal adherence at the time of suppression was associated with a 50% increased odds of experiencing subsequent VL rebound [odds ratio (OR) 1.51; 95% confidence interval (CI) 1.19-1.92; P = 0.0023], compared with high adherence.
  
  
  CONCLUSIONS
  Self-reported suboptimal adherence in people with VL suppression is associated with an increased risk of VL rebound. Our findings highlight the importance of continued adherence counselling, even in people with VL suppression, and to ensure that people with HIV infection maintain excellent adherence in order to minimize the risk of VL rebound.
authors.affiliation: Research Department of Infection and Population Health, University College London, London, UK.
authors.forename: J L
authors.initials: JL
authors.lastname: O'Connor
authors.affiliation: Denver Public Health, Denver, CO, USA.
authors.forename: E M
authors.initials: EM
authors.lastname: Gardner
authors.affiliation: Department of Dermatology and Venereology, HIV/STD Center, University Hospital Essen, Essen, Germany.
authors.forename: S
authors.initials: S
authors.lastname: Esser
authors.affiliation: Department of Medicine, Harlem Hospital, Columbia University College of Physicians & Surgeons, New York, NY, USA.
authors.forename: S B
authors.initials: SB
authors.lastname: Mannheimer
authors.affiliation: Division of Epidemiology and Community Health, School of Public Health, University of Minnesota, Minnesota, MN, USA.
authors.forename: A R
authors.initials: AR
authors.lastname: Lifson
authors.affiliation: Department of Medicine, SBH Health System, Albert Einstein College of Medicine, Bronx, NY, USA.
authors.forename: E E
authors.initials: EE
authors.lastname: Telzak
authors.affiliation: Research Department of Infection and Population Health, University College London, London, UK.
authors.forename: A N
authors.initials: AN
authors.lastname: Phillips
mesh_terms: D000328:Adult; D019380:Anti-HIV Agents / Q000627:therapeutic use*; D023241:Antiretroviral Therapy, Highly Active; D018791:CD4 Lymphocyte Count; D005500:Follow-Up Studies; D015658:HIV Infections / Q000188:drug therapy / Q000276:immunology* / Q000821:virology; D015497:HIV-1 / Q000276:immunology* / Q000502:physiology; D006801:Humans; D008875:Middle Aged; D011237:Predictive Value of Tests; D012307:Risk Factors; D057566:Self Report; D013997:Time Factors; D019562:Viral Load; D016903:Drug Monitoring
chemical_list: D019380:Anti-HIV Agents
keywords: HIV infection; antiretroviral drugs; drug adherence; drug resistance; self-report; viral load rebound