Predictors of undetectable plasma viral load in HIV-positive adults receiving antiretroviral therapy in Southern Brazil

Abstract

Factors associated with undetectable viral load (<80 copies/ml) were investigated among non-pregnant adults in antiretroviral treatment in a specialized service for HIV/AIDS in Southern Brazil. Use of antiretrovirals was investigated in two interviews (one month interval). Clinical data were collected from the clinical records; viral load previous to adherence measurement was defined the viral load previous to the first interview; the final viral load, the viral load subsequent to the second interview (interval between measures approximately 6 months). Undetectable final viral load occurred in 48% of the patients and was positively associated with levels of treatment adherence (p<0.001), being 19% for less than 60% of adherence and about 60% for adherence greater than 80%. In the multivariate model, the odds of undetectable final viral load was four times greater for 80-94% and > or =95% of adherence (CI 95% 1,80-13,28; CI 95% 1,73-9,53), compared with less than 60% adherence; it was greater for less than 6 months in treatment (OR = 3.37; CI 95% 1.09-10.46); and smaller for viral load previous to adherence measurement 5.2 log10 (OR = 0.19; CI95% 0.06-0.58), adjusted for these variables and sex, age, clinical status, current immune status, group of drugs and interval between the two measurements of viral load. The crude odds were lower for age 16-24 years and use of Nucleoside Analog Reverse Transcriptase Inhibitors only, but these effects were not significant in the multivariate model. There was no evidence of effect of sex, clinical status, current immune status, and changes in treatment regimen. Treatment adherence gave the largest effect. Motivational interventions directed at adherence may improve treatment effectiveness.

Suicide risk and alcohol and drug abuse in outpatients with HIV infection and Chagas disease

“…Data from the literature suggest that, on the one hand, alcohol or illicit drug abuse and psychiatric comorbidities are associated with low adherence to highly active antiretroviral therapy, 14 whereas on the other hand, viral load below the limit of detection 35 is a predictor of adherence. Moreover, a study of 4,989 outpatients conducted at five American hospitals observed that patients with six or more annual psychiatric visits had fewer episodes of ARV discontinuation (OR = 0.57, 95%CI 0.47-0.69) compared to those not receiving psychiatric treatment.…”

EVOLUTION OF PATIENTS WITH AIDS AFTER cART: CLINICAL AND LABORATORY EVOLUTION OF PATIENTS WITH AIDS AFTER 48 WEEKS OF ANTIRETROVIRAL TREATMENT

“…These authors accompanied patients naïve to cART for six years, and found that only 27.5% remained with levels below the limit of detection after one year of treatment with triple drug schemes, composed of both NNRTI and PI. For SILVEIRA et al 36 and CUÉLLAR…”

“…, an undetectable level as well as its maintenance for the longest possible period of time is associated with factors of compliance or non-compliance to treatment 7,36 such as education level, socioeconomic factors, side effects, the number of doses of medicaments and the evolution of clinical parameters 07 . Some authors 10,16 hypothesized that patient age, HIV-1 disease stage before cART initiation, immunological and virological responses to cART in the first five years of treatment and types of cART regimens would significantly affect later CD4+ count and RNA levels among long-term cART users.…”

Pesquisas brasileiras biomédicas e epidemiológicas face às metas da UNGASS

“…The base document of the United Nations General Assembly Special Session on HIV/AIDS (UNGASS) defines targets for Science, Technology and Innovation relating to HIV/AIDS in its items [70][71][72][73]. The present text analyses some of the main items in this section, giving emphasis to core questions in public health, rather than to its interfaces with broader markers for action within civil society, for formulation and implementation of public policies and for industrial policy strategies.…”