The Longer HIV Is Suppressed by Treatment, the Less Likely It Is to Rebound
The Longer HIV Is Suppressed by Treatment, the Less Likely It Is to Rebound
Lapses in adherence after long-term suppression do not seem to spell treatment failure.
Excellent adherence is known to be an important determinant of successful virologic suppression. However, for many patients, the years on treatment are turning into decades, and even the best intentions can lapse. Does adherence have to remain above 95% forever?
Researchers studied correlates of viral rebound among 1305 adults who initially had complete virologic responses to combination antiretroviral therapy started between 2000 and 2006. Overall, 274 individuals (21%) experienced rebound, after a median 2 years of suppression. Risk factors included younger age, injection-drug use, treatment initiation before 2002, and resistance to any class of antiretrovirals.
Longer duration of initial virologic suppression was protective against rebound: For each consecutive month that patients maintained suppression, their risk for rebound declined by 8%. This formula held true at all adherence levels (which were measured every 3 months and calculated as the number of days for which antiretroviral treatment was dispensed, divided by the number of days since the last appointment).
For individuals with <40% adherence, the likelihood of rebound was initially quite high (68% after 12 months of suppression) but then fell dramatically — to 5% after 72 months of suppression. At that point, the likelihood of losing virologic control was similar to that seen among individuals who maintained gold-standard adherence levels of ≥95% (4%).
Abstract and Introduction
Abstract
Lapses in adherence after long-term suppression do not seem to spell treatment failure.
Introduction
Excellent adherence is known to be an important determinant of successful virologic suppression. However, for many patients, the years on treatment are turning into decades, and even the best intentions can lapse. Does adherence have to remain above 95% forever?
Researchers studied correlates of viral rebound among 1305 adults who initially had complete virologic responses to combination antiretroviral therapy started between 2000 and 2006. Overall, 274 individuals (21%) experienced rebound, after a median 2 years of suppression. Risk factors included younger age, injection-drug use, treatment initiation before 2002, and resistance to any class of antiretrovirals.
Longer duration of initial virologic suppression was protective against rebound: For each consecutive month that patients maintained suppression, their risk for rebound declined by 8%. This formula held true at all adherence levels (which were measured every 3 months and calculated as the number of days for which antiretroviral treatment was dispensed, divided by the number of days since the last appointment).
For individuals with <40% adherence, the likelihood of rebound was initially quite high (68% after 12 months of suppression) but then fell dramatically — to 5% after 72 months of suppression. At that point, the likelihood of losing virologic control was similar to that seen among individuals who maintained gold-standard adherence levels of ≥95% (4%).