Modern NNRTI regimens can be effective with only 85% compliance

HIV and AIDS crossword puzzleSome modern HIV treatment regimens can achieve viral suppression with adherence at rates as low as 85%, US researchers have published in a cohort study with veterans on aging, in a report in the online edition of the Acquired Immune Deficiency Syndrome. The authors followed the trends of adherence and viral suppression between the 2001 and 2010 years. Both the rates of adherence and viral suppression have improved throughout the study. [Editor's note: It seems, at least in these respects, the efforts of doctors, nurses, and hospital pharmacy professionals have flourished positively, bringing a level of awareness to patients of AIDS or those living the HIV infection at a stage where they seem to be better able to understand the need to maintain a Spartan discipline, I would say draconian, as regards adherence and punctuality following medical prescription. Here, or anywhere else, this is the merit of dedicated health professionals and not of any governmental or non-governmental body.)

On the other hand, significant increases in viral suppression rates were observed among people with less than "perfect adherence," especially when subjects were taking non-nucleoside reverse transcriptase inhibitor (NNRTI) -based therapy.

"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 more antiretrovirals in combinations required at least taking 95% of doses at the right time and the right way to have the best chances of achieving an undetectable viral load. But it is not clear yet whether modern combinations require such a high level of adherence.

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.

At 2006, only 1% of patients were taking a single NNRTI-based therapy (emtricitabine and tenofovir / efavirenz), but this regimen had an increase of 29% in 2010. Therapy containing an integrase inhibitor was used by 11% of patients in 2010.

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, adhesion above 95% was associated with the highest rates of viral suppression, and the worst outcomes were observed even when patients were taking 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. "

By

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

Reference

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

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