Estimating the minimum antiretroviral adherence required for plasma HIV-1 RNA viral load suppression among people living with HIV who use unregulated drugs.
Journal
AIDS (London, England)
ISSN: 1473-5571
Titre abrégé: AIDS
Pays: England
ID NLM: 8710219
Informations de publication
Date de publication:
15 07 2022
15 07 2022
Historique:
entrez:
14
7
2022
pubmed:
15
7
2022
medline:
16
7
2022
Statut:
ppublish
Résumé
Owing to advances in antiretroviral therapy (ART), we re-examined minimum ART adherence levels necessary to achieve sustained HIV-1 viral load (VL) suppression among people with HIV who use drugs (PHIV-PWUD). We used data from ACCESS, a community-recruited prospective cohort of PHIV-PWUD in Vancouver, Canada. We calculated adherence using the proportion of days of ART dispensed in the year before each VL measurement. We used generalized linear mixed-effects models to identify adherence- and ART regimen-related correlates of VL suppression (<200 copies/ml). We employed probit regression models and generated dose-response curves to estimate the minimum adherence level needed to produce VL suppression in 90% of measures, stratified by regimen and calendar-year. Among 837 ART-exposed PHIV-PWUD recruited between 1996 and 2017, the overall estimated adherence level necessary to achieve 90% VL suppression was 93% (95% confidence interval [CI]: 90-96). This differed by regimen: 69% (95% CI: 45-92) for integrase inhibitor (INSTI)-, 96% (95% CI: 92-100) for boosted protease inhibitor (bPI)-, and 98% (95% CI: 91-100) for non-nucleoside reverse transcriptase inhibitor-based regimens. In multivariable analysis, INSTI-based regimens were positively associated with VL suppression (vs. bPIs), while un-boosted PIs and other regimens were negatively associated. We observed a decreasing temporal trend of estimated adherence necessary for 90% VL suppression, dropping to 64% (95% CI: 50-77) during 2016-2017. Although high levels of ART adherence were necessary to achieve consistent VL suppression, the minimum necessary adherence levels decreased over time. Overall, INSTI-based regimens performed the best, suggesting that they should be preferentially prescribed to PHIV-PWUD.
Identifiants
pubmed: 35833680
doi: 10.1097/QAD.0000000000003234
pii: 00002030-202207150-00004
pmc: PMC9342903
mid: NIHMS1797749
doi:
Substances chimiques
Anti-HIV Agents
0
Anti-Retroviral Agents
0
HIV Integrase Inhibitors
0
RNA
63231-63-0
Types de publication
Journal Article
Research Support, Non-U.S. Gov't
Research Support, N.I.H., Extramural
Langues
eng
Sous-ensembles de citation
IM
Pagination
1233-1243Subventions
Organisme : NIDA NIH HHS
ID : U01 DA021525
Pays : United States
Informations de copyright
Copyright © 2022 Wolters Kluwer Health, Inc. All rights reserved.
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