Antiretroviral Regimen and Suboptimal Medication Adherence Are Associated With Low-Level Human Immunodeficiency Virus Viremia

Abstract

Episodes of human immunodeficiency virus low-level viremia (LLV) are common in the clinical setting, but its association with antiretroviral therapy (ART) regimen and adherence remains unclear. Antiretroviral therapy adherence was evaluated in participants of the Research on Access to Care in the Homeless cohort by unannounced pill counts. Factors associated with increased risk of LLV include treatment with a protease inhibitor (PI)-based regimen (ritonavir-boosted PI vs nonnucleoside reverse-transcriptase inhibitor: adjusted hazard ratio [HR], 3.1; P = .01) and lower ART adherence over the past 3 months (HR, 1.1 per 5% decreased adherence, adjusted; P = .050). Patients with LLV may benefit from ART adherence counseling and potentially regimen modification.

Impact of Antiretroviral Regimens on Cerebrospinal Fluid Viral Escape in a Prospective Multicohort Study of Antiretroviral Therapy-Experienced Human Immunodeficiency Virus-1–Infected Adults in the United States

“…While reasons for ART switch were not available, plasma VL, duration of HIV infection, and nadir CD4 count were adjusted for in analyses, and the follow-up period was restricted to visits with plasma VL <1000 copies/mL on consecutive visits to reduce biases that result from virological failure. ART adherence is a critical factor in maintaining durable viral suppression [ 37 ] and could not be fully assessed due to missing data at the time of CSF escape. However, subanalyses of visits with suppressed plasma VL as a proxy for ART suppression showed that PI use remained an independent predictor of CSF escape.…”

Monotypic low-level HIV viremias during antiretroviral therapy are associated with disproportionate production of X4 virions and systemic immune activation

“…Plasma antiretroviral concentrations have infrequently been assessed in conjunction with LLV [ 3 , 34 , 36 , 46 ]. In agreement with our study, most LLV are not associated with decreased antiretroviral concentrations [ 3 , 34 , 36 ], although in one study, a sensitivity analysis found a modest association [ 46 ]. Co-administration of rifampin and NVP can diminish NVP concentrations because of activation of hepatic enzymes [ 47 ].…”

Factors influencing antiretroviral treatment suboptimal adherence among perinatally HIV-infected adolescents in Thailand

“…Despite increasing access to ART, several studies in Thailand and worldwide have found decreased adherence and rebound in mortality in adolescents receiving ART as compared to adults and young children[ 3 – 5 ], with poorer adherence when children advance in age[ 6 – 8 ]. Good adherence to the ART is crucial for successful viral suppression, as incomplete adherence leads to an increase in HIV viremia, risk of treatment failure, and accumulating resistance mutations[ 9 – 11 ].…”