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Impact of different types of adherence behaviours and of cART characteristics on plasma HIV-1 RNA detection under lower limit of quantification at real-time assay
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Reported by Jules Levin
EACS Nov 11-14 Cologne Germany
A. Ammassari1, M.P. Trotta1, M. Zaccarelli1, A. Amendola1, P. Sette1, M.L. Giancola1, P. Pierro1, V. Neri1, M.R. Capobianchi1, A. Antinori1
1INMI L Spallanzani, Rome, Italy
Objective: To investigate the impact of different non-adherence behaviours and cART characteristics on deep virological control.
Methods: Patients observed from Jan-Jun 2009 with adherence assessment and concomitant plasma viremia were eligible. Self-reported nonadherence was assessed: < 95% of ARVs taken in the last month (VAS); < 100% doses taken over the last week; timing deviation; drug holiday(s) over the last month; interruption in drug refill over last 3 months.
Plasma viremia was assessed by Abbott Real-Time HIV-1 RNA assay and ranked as follows:
1) < 40 cp/ml with undetectable viremia;
2) < 40 cp/ml with detectable viremia;
3) >40 cp/ml. Predictors of undetectable viremia were assessed in univariate and multivariate models.
Results:
326 patients evaluated: 55.5% had an undetectable viremia, 22.1% had detectable < 40 cp/ml, 22.4% >40 cp/ml.
Non-adherence was reported by 62.6%. An increasing proportion of subjects reporting non-adherence was found among HIV-RNA rankings (59.8%=1, 63.4%=2, 74.3%=3).
Drug holiday(s) significantly reduced the probability of having undetectable viremia (OR:0.18; 95%CI:0.07-0.46; P< 0.0001) from Jules: this is 2nd poster saying holidays were associated with 18% chance of virologic success.
Among ARV-related variables, EFV-based cART was the only factor associated with optimal virological control (OR:2.06; 95%CI:1.25-3.39; P=0.005).
On multivariate model adjusting for time spent on cART, both to report drug holiday(s) (OR:0.21; 95%CI:0.07-0.66; P=0.008) and receiving EFV-based cART (OR:2.09; 95% CI:1.17-3.74; P=0.01) were confirmed as independent predictors of optimal HIV-RNA plasma control.
In a separate model testing the interaction term, no evidence of interaction was found between the two predictors.
Conclusions: Finding of < 40 copies/ml with undetectable plasma HIV-1 RNA is associated with cART taken without interruptions and use of EFV. It is likely that for deep HIV replication control, drug holidays, in contrast to other non adherence behaviors, might determine higher virological rebound with more pronounced impact on virological control. EFV-based cART, independently from adherence, seems to determine a stronger antiviral activity, than that obtained by PI-based regimen.
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