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.

Comparing self-reported medication adherence measures with hair antiretroviral concentration among people living with HIV in Guangxi, China

“…However, despite the increased availability of antiretroviral medications, HIV-related morbidity, mortality, and new infection rate continually increased over the years in China from 2004 to 2016 [1]. Both clinical trials and cohort studies have shown that the effectiveness of antiretroviral medications is highly dependent on adherence [2][3][4]. Suboptimal adherence severely undercuts antiretroviral effectiveness and places PLHIV at risk for virologic failure, increases the risk of onward HIV transmission, and limits the impact of HIV treatment resources [5,6].…”

A Cascade of Interventions to Promote Adherence to Antiretroviral Therapy in African Countries

“…The UNAIDS 90-90-90 goals map the HIV care cascade in terms of knowledge of HIV status, sustained receipt of antiretroviral therapy (ART) and attainment of viral suppression [2]. The second and third '90s' are highly dependent on adherence [3,4]. Adherence to ART involves a number of components along the HIV care cascade, namely linking with care to initiate treatment, the need for ongoing engagement (e.g.…”

“…This scoping review discusses strategies to improve adherence for five target populations along five components of the HIV treatment cascade: (1) PLHIV who know their status and are not yet initiated on ART, (2) all PLHIV prescribed ART, (3) ART users with sub-optimal adherence, (4) ART users with stable adherence and (5) PLHIV initiated on treatment who disengage from care for periods of time or are lost to follow-up (LTFU). Within these categories, we make a special note of populations facing unique challenges, such as youth, pregnant women and those with common mental disorders.…”

Magnitude of non-adherence to antiretroviral therapy and associated factors among adult people living with HIV/AIDS in Benishangul-Gumuz Regional State, Ethiopia

“…Current evidence in the country has shown that only 32% of PLWHA on ART have suppressed viral loads ( UNAIDS, 2017 ). Studies have indicated that lack of viral suppression is an indication of non-adherence to ART ( Byrd et al, 2019 ; Nasuuna et al, 2018 ; Robbins et al, 2014 ). Therefore, understanding the level of adherence and factors related with non-adherence helps to prevent the future threat of widespread treatment resistant HIV strains.…”