title: Duration of Viral Suppression and Risk of Rebound Viremia with First-Line Antiretroviral Therapy in Rural Uganda.
abstract: Little is known about associations between viral suppression, adherence, and duration of prior viral suppression in sub-Saharan Africa. Study participants were from the UARTO study in Mbarara, Uganda. We fit regression models to characterize relationships between average adherence, treatment interruptions, and rebound viremia (>400 copies/mL) following a previously undetectable result. Our goal was to understand the impact of prior viral suppression on these relationships. 396 participants contributed 2864 quarterly visits. Restricted to periods with average adherence <50 %, each 10 % increase in adherence reduced the odds of rebound viremia by 74 % [adjusted odds ratio (AOR) = 0.26, P = 0.002] and 29 % (AOR = 0.71, P = 0.057) during the first 12 months of suppression and beyond 12 months respectively, interaction term P = 0.018. Among periods with adherence ≥50 %, the risk of rebound viremia decreased with increasing adherence during the first 12 months of viral suppression (AOR = 0.73 for each 10 % increase, P = 0.001), but not thereafter (AOR = 1.09, P = 0.67), interaction term P = 0.027. In contrast, 72-h interruptions, were associated with increased rebound viremia during the first 12 months (AOR = 1.30, P = 0.009) and after (AOR = 1.39, P = 0.005), interaction term P = 0.69. Completing 12 months of viral suppression decreases the impact of average adherence, but not prolonged treatment interruptions, on risk of rebound viremia.
authors.affiliation: Global Health Collaborative, Mbarara University of Science and Technology, Plot 10/24, Lower Circular Road, Mbarara, Uganda. nmusinguzi@gmail.com.
authors.forename: Nicholas
authors.initials: N
authors.lastname: Musinguzi
authors.affiliation: School of Medicine, University of California in San Francisco, San Francisco, CA, USA.
authors.forename: Rain A
authors.initials: RA
authors.lastname: Mocello
authors.affiliation: Epicentre Research Base, Mbarara, Uganda.
authors.forename: Yap
authors.initials: Y
authors.lastname: Boum
authors.affiliation: School of Medicine, University of California in San Francisco, San Francisco, CA, USA.
authors.forename: Peter W
authors.initials: PW
authors.lastname: Hunt
authors.affiliation: School of Medicine, University of California in San Francisco, San Francisco, CA, USA.
authors.forename: Jeffrey N
authors.initials: JN
authors.lastname: Martin
authors.affiliation: Center for Global Health, Massachusetts General Hospital, Boston, MA, USA.|Harvard Medical School, Harvard University, Boston, MA, USA.
authors.forename: Jessica E
authors.initials: JE
authors.lastname: Haberer
authors.affiliation: Center for Global Health, Massachusetts General Hospital, Boston, MA, USA.|Harvard Medical School, Harvard University, Boston, MA, USA.
authors.forename: David R
authors.initials: DR
authors.lastname: Bangsberg
authors.affiliation: Center for Global Health, Massachusetts General Hospital, Boston, MA, USA.|Harvard Medical School, Harvard University, Boston, MA, USA.
authors.forename: Mark J
authors.initials: MJ
authors.lastname: Siedner
mesh_terms: D019380:Anti-HIV Agents / Q000627:therapeutic use*; D023241:Antiretroviral Therapy, Highly Active / Q000379:methods*; D005260:Female; D015658:HIV Infections / Q000188:drug therapy* / Q000821:virology*; D006801:Humans; D008297:Male; D055118:Medication Adherence; D016017:Odds Ratio; D012306:Risk; D012424:Rural Population; D016896:Treatment Outcome; D014454:Uganda; D019562:Viral Load / Q000187:drug effects*; D014766:Viremia
chemical_list: D019380:Anti-HIV Agents
keywords: ART; Adherence; Suppression; Viremia