Adherence to antiretroviral therapy (ART) in the first months after the start of treatment
is crucial to the long-term results, suggests French research published in the online edition of the Journal of Acquired Immune Deficiency Syndromes. People who took all or almost all of their doses in the first four months after the start of ART were about four times more likely to have prolonged viral suppression up to 12 years of follow-up, compared to people who often did not take these doses. The findings also showed the importance of maintaining high levels of adhesion during long-term therapy.
"This unexpected long-term impact of early virologic adherence reinforces the message that, when starting antiretrovirals, all means should be mobilized to ensure optimal early adherence to achieve prolonged antiretroviral success," comment the authors.
Membership is the most important factor under the control of people living with HIV that determines the success of ART. The goal of treatment is an undetectable viral load, a result associated with at least 95% of grip levels with older anti-HIV drugs (though modern therapies are more tolerant of missed doses).
Researchers from the prospective cohort, multicenter French APROCO-COPILOTE wanted to observe the very early adherence to antiretroviral therapy (the first four months of treatment) was associated with long-term viral suppression (up to 12 years of follow-up).
The study population consisted of 891 people who started ART based on a first-generation protease inhibitor between 1997 and 1999. They were followed for an average of nine to eleven years. Self reported adherence data were collected four months after beginning treatment. The membership would be considered "high" if people take 100% of their doses, "average" if between 99,9% to 80% of doses were taken and low if less than 80% of doses were taken in the previous four days. Other data on adherence were collected at regular intervals during follow-up.
Baseline characteristics were as follows: mean age of 37 years 21% of women with AIDS 20%, with an average count of CD4 286 cells / mm3 and viral load 29.000 copies / ml on average.
The proportion of people with prolonged virologic suppression increased 48 20% in the month follow-up intervals to 73 12% after years of therapy.
In 4 month, 57% of people had high adherence, 33% had average membership and 10% had low grip. During follow-up, 66% of people remained high grip, 25% fluctuated between high and medium grip and 9% had at least one episode of low adhesion.
There was clear evidence that early adhesion was associated with long-term results.
The high adhesion and medium versus low grip in 4 month of therapy was significantly associated with higher chances of prolonged virologic suppression (adjusted OR of 3,73, 95% CI: 1,98-6,98).
The maintenance of good adherence was also associated with improved virologic outcome between the 20 and 144 months after beginning treatment. Compared to people with a degree of weak adhesion, individuals with high and moderate adherence were more than three (adjusted OR 3,28 CI 95% 2,64-4,08) and two (adjusted OR 2,26 CI 95%: 1,81-2,83) Suppression persistent viral.
"Interventions aimed to increase adherence need to be implemented both in the initiation of antiretroviral treatment and during treatment," the authors write.
They call for more studies looking at the impact of early grip on long-term results with modern antiretroviral drugs, more potent that are more tolerant of missed doses.
Translated by Claudio Souza's original Early adherence to ART key to long-term virological outcomesWritten by Michael Carter for Aidsmap Published in 14 March 2017
Protopopescu C et al.Prolonged viral suppression over the 12-year follow-up of HIV-infected Patients: the persistent impact of adherence at 4 months after initiation of combined antiretroviral therapy in the ANRS CO8 APROCO-COPILOTE cohort. J Acquir Immune Defic Syndr, online edition. DOI: 10.1097 / QAI.0000000000001249 (2017).