Modern NNRTI regimens can be effective with only 85% compliance

HIV and AIDS crossword puzzleSome modern HIV treatment regimens can achieve viral suppression with grip with rates as low as 85%, US researchers published a cohort study on aging veterans, a report in the journal online editionAcquired Immune Deficiency Syndrome.The authors followed the trends of adherence and viral suppression between the 2001 and 2010 years. Both adherence and viral suppression rates improved throughout the study [Editor's note:. Apparently, at least in these aspects of medical efforts, nurses, hospital pharmacy professionals has blossomed positively, bringing a level of consciousness to patients AIDS or those who live HIV infection at a stage where they seem to be better understanding the need to maintain a Spartan discipline - I would say draconian - with regard to adherence and punctuality following the prescription. Here, or anywhere else that is health professionals dedicated merit and not any government body or non-governmental).

Moreover, significant increases in viral suppression rates were observed among persons aged less than the "perfect adherence", especially when subjects were taking therapy based reverse transcriptase inhibitors, non-nucleoside (NNRTI).

"Our data suggest that a membership at levels below 95% may be sufficient to viral suppression in people with the new NNRTI formulations," write the authors, "85-89% membership-based regimes with new formulations of NNRTI may be sufficient to viral suppression. "

The goal of therapy with HIV is an undetectable viral load. The proportion of people achieving viral suppression (defined in this study as viral load below 400 copies / ml (Editor's note: This number is American specification, since in Brazil viral load tests are more sensitive and only undetectable viral load less than 40 copies of viral RNA per milliliter of blood, which puts me in doubt the validity of this article that only public to give doctors Brazilians the opportunity of reviewing the case, within their ethical standards that I regard excellent) It has increased dramatically in recent years.

This is partly due to improvements in modern antiretroviral drugs that have a good safety profile with a strong and durable antiretroviral component. Furthermore, most have simple dosages and schedules and the number of fixed doses, as well as the combination of more than two or three drugs in each pill are now available and provide an effective treatment, sometimes in a single pill daily.

Research involving people suggests that combinations with antiretrovirals in combinations that needed at least of making 95% of doses at the right time and the right way to have the best chance of achieving an undetectable viral load. But it is unclear even if modern combinations require a high level of grip.

To answer this question, researchers monitored adherence rates and viral suppression between 22.000 HIV-positive patients over a period of ten years. The authors wanted especially observed that the adhesion levels necessary to achieve an undetectable viral load differ between treatment regimens based NNRTI, protease inhibitors and newer agents, such as integrase inhibitors. Adherence was assessed using the refueling of hospital pharmacies. The researchers acknowledged that this aspect is not the most appropriate form of assessment of adherence and yet I believe it is more reliable than the memory of a patient, said one of the authors.

Participants had a mean age of 46 years and contributed approximately 82.000 people / year medical follow-up (statistics).

The proportion of people taking a complicated, multidrug regimen with protease inhibitor or NNRTI-based regimens in decline during the 65% follow-up to 43%, and 33% to 16% respectively.

In 2006 only 1% of patients were taking a one pill NNRTI-based therapy (emtricitabine and tenofovir / efavirenz), but the scheme has increased in 29 2010%. Therapy that contains an integrase inhibitor has been used for 11 2010% of patients.

The proportion of people with 95% or greater adherence increased from 37% in 2001 42% for in 2010. The authors described the increase as "marginal". (Translator's note: Something made me think of the symbolism of convenience).

People living in NNRTI based regimens were more likely to have an almost perfect adhesion than those using combination therapies containing a protease inhibitor. Users of a therapy in a single pill had better grip than people having multipílula regimens. (This is not the NNRTI itself. Any therapeutic systems in which it is applied a single daily dose of one tablet will, for simplicity, ease of grip)

Analysis of people with membership below 95%, showed the proportion with viral suppression increased from 38% in 2001 94% for in 2010. The increase in the rates of viral suppression was observed even among people with such a low adhesion as 70 - 75%.

The proportion of people with sustained viral suppression increased from 78% in 2001 92% for in 2010.

In general, the chances of getting viral suppression were the same for people with a membership of between 90-94% and people with membership above 95%. (Editor's note: the criterion of detectability is this 400 copies of viral RNA per milliliter of blood, I think all this is very questionable)

Comparison of patients according to scheme type showed that at all levels of adhesion, viral suppression rates were higher among individuals NNRTI therapy.

For people taking a protease inhibitor, joining up 95% was associated with higher rates of viral suppression, and the worst outcomes were observed even when the patients were taking between 90-94% of their doses.

However, for people taking NNRTI-based therapy level, a membership 85% was associated with just how high the probability of achieving an undetectable viral load as membership fees of 95% or above.

"Vendors should not let concerns about obstacles to accession prevent the prescription of new HAART regimens (antiretroviral therapy highly active in free translation) In the early stages of the disease, "the authors suggest. "Efforts should be made to maximize revenue and the use of a single pill regimens. Future work should focus on the use of other multidrug combinations / pill treatment regimens and newer drugs now included as recommended regimens in the most recent guidelines, and its use in populations with limited access to and maintenance care. "


Michael Carter

Published: 12 May 2015 in Modern NNRTI regimens can be effective with 85% adherence Translated by Claudio Souza and Revised by Mara Macedo in July 10 2015


Viswanathan et al.HIV RNA suppression membership and in the current era of highly active antiretroviral therapy (HAART).Acquired immune J Defic Syndr, online edition. DOI: 10 / 1097 / QAI.0000000000000643 until 2015.