Determinants of Sustained Viral Suppression in HIV-Infected Patients with Self-Reported Poor Adherence to Antiretroviral Therapy

Publication

Determinants of Sustained Viral Suppression in HIV-Infected Patients with Self-Reported Poor Adherence to Antiretroviral Therapy

Journal Paper/Review - Jan 3, 2012

Glass Tracy R, Marzolini Catia, Battegay Manuel, Wandeler Gilles, Bernasconi Enos, Hirschel Bernard, Nicca Dunja, Rickenbach Martin, Günthard Huldrych F, Bucher Heiner C, Csajka Chantal, Decosterd Laurent, Telenti Amalio, Rotger Margalida, the Swiss HIV Cohort Study

Citation

Glass T, Marzolini C, Battegay M, Wandeler G, Bernasconi E, Hirschel B, Nicca D, Rickenbach M, Günthard H, Bucher H, Csajka C, Decosterd L, Telenti A, Rotger M, the Swiss HIV Cohort Study. Determinants of Sustained Viral Suppression in HIV-Infected Patients with Self-Reported Poor Adherence to Antiretroviral Therapy. PloS one 2012; 7:e29186.

Type

Journal Paper/Review (English)

Journal

PloS one 2012; 7

Publication Date

Jan 3, 2012

Issn Electronic

1932-6203

Pages

e29186

Brief description/objective

BACKGROUND: Good adherence to antiretroviral therapy (ART) is critical for successful HIV treatment. However, some patients remain virologically suppressed despite suboptimal adherence. We hypothesized that this could result from host genetic factors influencing drug levels. METHODS: Eligible individuals were Caucasians treated with efavirenz (EFV) and/or boosted lopinavir (LPV/r) with self-reported poor adherence, defined as missing doses of ART at least weekly for more than 6 months. Participants were genotyped for single nucleotide polymorphisms (SNPs) in candidate genes previously reported to decrease EFV (rs3745274, rs35303484, rs35979566 in CYP2B6) and LPV/r clearance (rs4149056 in SLCO1B1, rs6945984 in CYP3A, rs717620 in ABCC2). Viral suppression was defined as having HIV-1 RNA <400 copies/ml throughout the study period. RESULTS: From January 2003 until May 2009, 37 individuals on EFV (28 suppressed and 9 not suppressed) and 69 on LPV/r (38 suppressed and 31 not suppressed) were eligible. The poor adherence period was a median of 32 weeks with 18.9% of EFV and 20.3% of LPV/r patients reporting missed doses on a daily basis. The tested SNPs were not determinant for viral suppression. Reporting missing >1 dose/week was associated with a lower probability of viral suppression compared to missing 1 dose/week (EFV: odds ratio (OR) 0.11, 95% confidence interval (CI): 0.01-0.99; LPV/r: OR 0.29, 95% CI: 0.09-0.94). In both groups, the probability of remaining suppressed increased with the duration of continuous suppression prior to the poor adherence period (EFV: OR 3.40, 95% CI: 0.62-18.75; LPV/r: OR 5.65, 95% CI: 1.82-17.56). CONCLUSIONS: The investigated genetic variants did not play a significant role in the sustained viral suppression of individuals with suboptimal adherence. Risk of failure decreased with longer duration of viral suppression in this population.