Early Maintenance Of Antiretroviral Therapy Is Important For Reducing Later AIDS Risk
Published: Oct 2, 2009 1:46 pm
A study published September 29 in PLoS One has provided patients with yet another reason to maintain their prescribed antiretroviral therapy (ART). Scientists found that the longer a patient suppresses HIV through ART, the lower the chance of virologic failure, or spike in viral load.
An HIV patient’s level of diligence in taking their medicine can be as good a predictor of their future success with the virus as their CD4 cell count. The practice of taking medication correctly and regularly is known as adherence.
Incomplete adherence, such as frequently forgetting to take pills, has been associated with patients’ development of drug-resistant virus strains as well as progression of HIV to AIDS.
In this study, researchers followed 221 HIV patients and measured their level of adherence to their ART regimens over a 12-month period. Each month, patients were also assessed for the amount of HIV RNA in their bloodstreams.
A count less than 50 HIV RNA copies/mL indicates successful suppression of the virus. Anything more is considered a failure to resist the virus, or “virologic failure.”
Using this data, researchers were able to estimate each patient’s risk of virologic failure every month. They also took into account other factors such as previous treatment, recent CD4 cell counts, demographics, type of ART, and drug use.
The study concluded that patients who practice adherence above 50 percent generally maintain suppression of the virus. Patients with lower percentages of adherence were more likely to have virologic failure than patients with higher adherence.
Additionally, the longer viral suppression was maintained, the smaller the risk of virologic failure. For example, a patient with 50 percent adherence was more likely to have virologic failure after one month of successful suppression than after 12 months of suppression.
This indicates that high adherence to ART is most important at the beginning of a treatment regimen. After twelve months of at least 50 percent adherence, patients’ estimated risk of virologic failure decreased by nearly half.
Adherence in this study was based on how many pills a patient took on time versus how many they were supposed to. For ART patients, the current average rate of adherence is estimated to be roughly 70 percent.
If the results of this study are confirmed, it could mean alternative methods of treating HIV are possible. For example, if a patient begins treatment with a more intense drug and maintains adherence, they might be able to switch to a weaker drug regimen later on – one that induces fewer side effects – without increasing their risk.
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