Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2012;7(1):e29186.
doi: 10.1371/journal.pone.0029186. Epub 2012 Jan 3.

Determinants of sustained viral suppression in HIV-infected patients with self-reported poor adherence to antiretroviral therapy

Tracy R Glass  1 , Margalida Rotger, Amalio Telenti, Laurent Decosterd, Chantal Csajka, Heiner C Bucher, Huldrych F Günthard, Martin Rickenbach, Dunja Nicca, Bernard Hirschel, Enos Bernasconi, Gilles Wandeler, Manuel Battegay, Catia Marzolini; Swiss HIV Cohort Study
Collaborators, Affiliations

Determinants of sustained viral suppression in HIV-infected patients with self-reported poor adherence to antiretroviral therapy

Tracy R Glass et al. PLoS One. 2012.

Abstract

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.

PubMed Disclaimer

Conflict of interest statement

Competing Interests: The authors have read the journal's policy and have the following conflicts: HCB has received travel grants, honoraria and unrestricted research grants from GlaxoSmithKline, Bristol-Myers-Squibb, Merck Sharp & Dohme, Gilead, Janssen, Roche, Abbott, Tibotec, Boehringer-Ingelheim and ViiV Healthcare. HFG has been an adviser and/or consultant for the following companies: GlaxoSmithKline, Abbott, Novartis, Boehringer Ingelheim, Roche, Tib tec and Bristol-Myers Squibb, and has received unrestricted research and educational grants from Roche, Abbott, Bristol-Myers Squibb, GlaxoSmithKline, Tibotec and Merck Sharp & Dohme (integral financial support went to the institution). EB received honoraria or travel grants from the following pharmaceutical companies: Abbott, Bristol-Myers Squibb, Boehringer Ingelheim, Gilead, ViiV Healthcare, Merck Sharp & Dohme, Janssen. MB has received speaker's honoraria from Boehringer Ingelheim, Bristol-Myers Squibb, Gilead Sciences, GlaxoSmithKline, Merck Sharp & Dohme and Tibotec and has received unrestricted research grants from Boehringer Ingelheim, Gilead Sciences, GlaxoSmithKline and serves as a consultant for Boehringer Ingelheim Switzerland. TRG, MR, AT, LD, CC, MR, DN, BH, GW, and CM declare no competing interests. This does not alter the authors' adherence to all the PLoS ONE policies on sharing data and materials.

Figures

Figure 1
Figure 1. Selection of the study population.
See this image and copyright information in PMC

References

    1. Paterson DL, Swindells S, Mohr J, Brester M, Vergis EN, et al. Adherence to protease inhibitor therapy and outcomes in patients with HIV infection. Ann Intern Med. 2000;133:21–30. - PubMed
    1. Bangsberg DR. Less than 95% adherence to nonnucleoside reverse-transcriptase inhibitor therapy can lead to viral suppression. Clin Infect Dis. 2006;43:939–941. - PubMed
    1. Maggiolo F, Ravasio L, Ripamonti D, Gregis G, Quizan G, et al. Similar adherence rates favor different virologic outcomes for patients treated with nonnucleoside analogues or protease inhibitors. Clin Infect Dis. 2005;40:158–163. - PubMed
    1. Lima VD, Harrigan R, Murray M, Moore DM, Wood E, et al. Differential impact of adherence on long-term treatment response among naive HIV-infected individuals. AIDS. 2008;22:2371–2380. - PubMed
    1. Marzolini C, Buclin T, Decosterd LA, Biollaz J, Telenti A. Nelfinavir plasma levels under twice-daily and three-times-daily regimens: high interpatient and low intrapatient variability. Ther Drug Monit. 2001;23:394–398. - PubMed

Publication types

Substances