HIV/AIDS HAART: Reduced adherence only partly explains differences in viral suppression from HAART regimens

AIDSWEEKLY Plus; Monday, July 31, 2006
Staff Medical Writers

In a recent report, researchers in Canada conducted a study to "examine differences among four protease inhibitor (PI)-based drug regimens in adherence to therapy and rate of achievement of virological suppression in a cohort of antiretroviral-naive patients initiating highly active antiretroviral therapy (HAART).

"Participants were antiretroviral-naive and were first dispensed combination therapy containing two nucleosides and a ritonavir (RTV)-boosted PI, or unboosted nelfinavir, between January 1, 2000 and September 30, 2003."

"Logistic regression analysis was used to examine associations between the prescribed PI and other baseline factors associated with being >90% adherent to therapy and then to determine the associations of prescribed drug regimen, adherence to therapy and baseline variables with the odds of achieving two consecutive viral loads of <500 HIV-1 RNA copies/mL.

"A total of 385 subjects were available for analysis. Lopinavir (LPV)/RTV was prescribed for 168 patients (42% of total); 86 (22%) received indinavir (IDV)/RTV; 91 (24%) received nelfinavir (NFV) and 40 (10%) received saquinavir (SQV)/RTV. SQV/RTV-based HAART was associated with reduced adherence to therapy [odds ratio (OR)=0.40; 95% confidence interval (CI) 0.19-0.83]," researchers said.

"In multivariate models, IDV/RTV (OR=0.45; 95% CI 0.22-0.92), SQV/RTV (OR=0.18; 95% CI 0.07-0.43) and NFV were associated with reduced odds of achieving virological suppression within 1 year in comparison to LPV/RTV-based therapy.

"For patients receiving NFV," wrote D.M. Moore and colleagues at the British Columbia Center for Excellence in HIV/AIDS in Vancouver, "adjusting for adherence (OR=0.73; 95% CI 0.36-1.47) rendered this association nonsignificant."

The authors concluded, "Patients prescribed IDV/RTV, NFV or SQV/RTV were less likely to achieve virological suppression on their first regimen compared with patients prescribed LPV/RTV. Reduced adherence to these therapies only partly explained these observed differences."

Moore and colleagues published their study in HIV Medicine (Regimen-dependent variations in adherence to therapy and virological suppression in patients initiating protease inhibitor-based highly active antiretroviral therapy. HIV Med, 2006;7(5):311-316).

For additional information, contact D.M. Moore, British Columbia Center Excellence HIV AIDS, 608-1081 Burrard St., Vancouver, BC V6Z 1Y6, Canada.

Publisher contact information for the journal HIV Medicine is: Blackwell Publishing, 9600 Garsington Rd., Oxford OX4 2DQ, Oxon, England.

Keywords: Vancouver, British Columbia, Canada, HIV/AIDS, Reduced Drug Adherence, HAART Regimen, Virologic Suppression.

This article was prepared by AIDS Weekly editors from staff and other reports.

2006-07-31
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