Antiretroviral Adherence Level Necessary for HIV Viral Suppression Using Real-World Data

Patient-Centered HIV Care Model Team

Research output: Contribution to journalArticle

Abstract

BACKGROUND: A benchmark of near-perfect adherence (≥95%) to antiretroviral therapy (ART) is often cited as necessary for HIV viral suppression. However, given newer, more effective ART medications, the threshold for viral suppression may be lower. We estimated the minimum ART adherence level necessary to achieve viral suppression. SETTINGS: The Patient-centered HIV Care Model demonstration project. METHODS: Adherence to ART was calculated using the proportion of days covered measure for the 365-day period before each viral load test result, and grouped into 5 categories (<50%, 50% to <80%, 80% to <85%, 85% to <90%, and ≥90%). Binomial regression analyses were conducted to determine factors associated with viral suppression (HIV RNA <200 copies/mL); demographics, proportion of days covered category, and ART regimen type were explanatory variables. Generalized estimating equations with an exchangeable working correlation matrix accounted for correlation within subjects. In addition, probit regression models were used to estimate adherence levels required to achieve viral suppression in 90% of HIV viral load tests. RESULTS: The adjusted odds of viral suppression did not differ between persons with an adherence level of 80% to <85% or 85% to <90% and those with an adherence level of ≥90%. In addition, the overall estimated adherence level necessary to achieve viral suppression in 90% of viral load tests was 82% and varied by regimen type; integrase inhibitor- and nonnucleoside reverse transcriptase inhibitor-based regimens achieved 90% viral suppression with adherence levels of 75% and 78%, respectively. CONCLUSIONS: The ART adherence level necessary to reach HIV viral suppression may be lower than previously thought and may be regimen-dependent.

Original languageEnglish
Pages (from-to)245-251
Number of pages7
JournalJournal of acquired immune deficiency syndromes (1999)
Volume82
Issue number3
DOIs
StatePublished - 1 Nov 2019

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HIV
Viral Load
Therapeutics
Integrase Inhibitors
Benchmarking
Patient-Centered Care
Reverse Transcriptase Inhibitors
Regression Analysis
Demography
RNA

Cite this

@article{0c4bf461e0fe4c91b63ebb47ab5d8e1f,
title = "Antiretroviral Adherence Level Necessary for HIV Viral Suppression Using Real-World Data",
abstract = "BACKGROUND: A benchmark of near-perfect adherence (≥95{\%}) to antiretroviral therapy (ART) is often cited as necessary for HIV viral suppression. However, given newer, more effective ART medications, the threshold for viral suppression may be lower. We estimated the minimum ART adherence level necessary to achieve viral suppression. SETTINGS: The Patient-centered HIV Care Model demonstration project. METHODS: Adherence to ART was calculated using the proportion of days covered measure for the 365-day period before each viral load test result, and grouped into 5 categories (<50{\%}, 50{\%} to <80{\%}, 80{\%} to <85{\%}, 85{\%} to <90{\%}, and ≥90{\%}). Binomial regression analyses were conducted to determine factors associated with viral suppression (HIV RNA <200 copies/mL); demographics, proportion of days covered category, and ART regimen type were explanatory variables. Generalized estimating equations with an exchangeable working correlation matrix accounted for correlation within subjects. In addition, probit regression models were used to estimate adherence levels required to achieve viral suppression in 90{\%} of HIV viral load tests. RESULTS: The adjusted odds of viral suppression did not differ between persons with an adherence level of 80{\%} to <85{\%} or 85{\%} to <90{\%} and those with an adherence level of ≥90{\%}. In addition, the overall estimated adherence level necessary to achieve viral suppression in 90{\%} of viral load tests was 82{\%} and varied by regimen type; integrase inhibitor- and nonnucleoside reverse transcriptase inhibitor-based regimens achieved 90{\%} viral suppression with adherence levels of 75{\%} and 78{\%}, respectively. CONCLUSIONS: The ART adherence level necessary to reach HIV viral suppression may be lower than previously thought and may be regimen-dependent.",
author = "{Patient-Centered HIV Care Model Team} and Byrd, {Kathy K.} and Hou, {John G.} and Ron Hazen and Heather Kirkham and Sumihiro Suzuki and Clay, {Patrick G.} and Tim Bush and Camp, {Nasima M.} and Weidle, {Paul J.} and Ambrose Delpino",
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Antiretroviral Adherence Level Necessary for HIV Viral Suppression Using Real-World Data. / Patient-Centered HIV Care Model Team.

In: Journal of acquired immune deficiency syndromes (1999), Vol. 82, No. 3, 01.11.2019, p. 245-251.

Research output: Contribution to journalArticle

TY - JOUR

T1 - Antiretroviral Adherence Level Necessary for HIV Viral Suppression Using Real-World Data

AU - Patient-Centered HIV Care Model Team

AU - Byrd, Kathy K.

AU - Hou, John G.

AU - Hazen, Ron

AU - Kirkham, Heather

AU - Suzuki, Sumihiro

AU - Clay, Patrick G.

AU - Bush, Tim

AU - Camp, Nasima M.

AU - Weidle, Paul J.

AU - Delpino, Ambrose

PY - 2019/11/1

Y1 - 2019/11/1

N2 - BACKGROUND: A benchmark of near-perfect adherence (≥95%) to antiretroviral therapy (ART) is often cited as necessary for HIV viral suppression. However, given newer, more effective ART medications, the threshold for viral suppression may be lower. We estimated the minimum ART adherence level necessary to achieve viral suppression. SETTINGS: The Patient-centered HIV Care Model demonstration project. METHODS: Adherence to ART was calculated using the proportion of days covered measure for the 365-day period before each viral load test result, and grouped into 5 categories (<50%, 50% to <80%, 80% to <85%, 85% to <90%, and ≥90%). Binomial regression analyses were conducted to determine factors associated with viral suppression (HIV RNA <200 copies/mL); demographics, proportion of days covered category, and ART regimen type were explanatory variables. Generalized estimating equations with an exchangeable working correlation matrix accounted for correlation within subjects. In addition, probit regression models were used to estimate adherence levels required to achieve viral suppression in 90% of HIV viral load tests. RESULTS: The adjusted odds of viral suppression did not differ between persons with an adherence level of 80% to <85% or 85% to <90% and those with an adherence level of ≥90%. In addition, the overall estimated adherence level necessary to achieve viral suppression in 90% of viral load tests was 82% and varied by regimen type; integrase inhibitor- and nonnucleoside reverse transcriptase inhibitor-based regimens achieved 90% viral suppression with adherence levels of 75% and 78%, respectively. CONCLUSIONS: The ART adherence level necessary to reach HIV viral suppression may be lower than previously thought and may be regimen-dependent.

AB - BACKGROUND: A benchmark of near-perfect adherence (≥95%) to antiretroviral therapy (ART) is often cited as necessary for HIV viral suppression. However, given newer, more effective ART medications, the threshold for viral suppression may be lower. We estimated the minimum ART adherence level necessary to achieve viral suppression. SETTINGS: The Patient-centered HIV Care Model demonstration project. METHODS: Adherence to ART was calculated using the proportion of days covered measure for the 365-day period before each viral load test result, and grouped into 5 categories (<50%, 50% to <80%, 80% to <85%, 85% to <90%, and ≥90%). Binomial regression analyses were conducted to determine factors associated with viral suppression (HIV RNA <200 copies/mL); demographics, proportion of days covered category, and ART regimen type were explanatory variables. Generalized estimating equations with an exchangeable working correlation matrix accounted for correlation within subjects. In addition, probit regression models were used to estimate adherence levels required to achieve viral suppression in 90% of HIV viral load tests. RESULTS: The adjusted odds of viral suppression did not differ between persons with an adherence level of 80% to <85% or 85% to <90% and those with an adherence level of ≥90%. In addition, the overall estimated adherence level necessary to achieve viral suppression in 90% of viral load tests was 82% and varied by regimen type; integrase inhibitor- and nonnucleoside reverse transcriptase inhibitor-based regimens achieved 90% viral suppression with adherence levels of 75% and 78%, respectively. CONCLUSIONS: The ART adherence level necessary to reach HIV viral suppression may be lower than previously thought and may be regimen-dependent.

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DO - 10.1097/QAI.0000000000002142

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JO - Journal of Acquired Immune Deficiency Syndromes

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SN - 1525-4135

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