Adherence patterns and their influence on virologic outcome are well characterized for protease inhibitor (PI)- and non-nucleoside reverse transcriptase inhibitor (NNRTI)–based regimens. We aimed to determine how patterns of adherence to raltegravir influence the risk of virological failure. We conducted a prospective multicenter cohort following 81 HIV-infected antiretroviral-naive or experienced subjects receiving or starting twice-a-day raltegravir-based antiretroviral therapy. Their adherence patterns were monitored using the Medication Events Monitoring System. During follow-up (188 days, ±77), 12 (15%) of 81 subjects experienced virological failure. Longer treatment interruption [adjusted odds ratio per 24-hour increase: 2.4; 95% confidence interval: 1.2 to 6.9; P < 0.02] and average adherence (odds ratio per 5% increase: 0.68; 95% confidence interval: 0.46 to 1.00, P < 0.05) were both independently associated with virological failure controlling for prior duration of viral suppression. Timely interdose intervals and high levels of adherence to raltegravir are both necessary to control HIV replication.
*Department of Infectious Diseases, Centre Hospitalier Universitaire, Tours, France
†Community Pharmacy, Department of Ambulatory Care & Community Medicine, University of Lausanne, Lausanne, Switzerland
‡Infectious Diseases Service, Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland
§Department of Infectious Diseases, Centre Hospitalier Universitaire, Saint-Etienne, France
‖Department of Pharmacology, Centre Hospitalier Universitaire, Caen, France
¶Infectious Diseases Service, Centre Hospitalier Universitaire, Caen, France
#Department of Biostatistics and Clinical Research, Centre Hospitalier Universitaire, Caen, France.
Correspondence to: Jean-Jacques Parienti, MD, PhD, Department of Biostatistics and Clinical Research, Centre Hospitalier Universitaire, Avenue de la Côte de Nacre, 14000 Caen, France (e-mail: firstname.lastname@example.org).
Supported by academic research grant from the Caen University Hospital, France.
Presented in part at the 6th International Conference on HIV Treatment and Prevention Adherence, May 22–24, 2011, Miami, Florida and 6th International AIDS Society Conference on HIV Pathogenesis and Prevention, July 17–20, 2011, Rome, Italy.
The authors have no funding or conflicts of interest to disclose.
RALTECAPS Study Group: V. Laplantine, A. Chaillon, F. Bastides, F. Barin, A. Martin, V. Noyon, S. Dargere, A. de la Blanchardière, P. Goubin, P. Feret, A.C. Maelle Detoc, J. Dina, A. Vabret, J.-J. Dutheil, F. Chaillot, D. Alves, O. Bugnon. This study has been supported in part, by the Swiss HIV Cohort Study. The members of the Swiss HIV Cohort Study are J. Barth, M. Battegay, E. Bernasconi, J. Böni, HC. Bucher, C. Burton-Jeangros, A. Calmy, M. Cavassini, C. Cellerai, M. Egger, L. Elzi, J. Fehr, J. Fellay, M. Flepp, P. Francioli (President of the SHCS), H. Furrer (Chairman of the Clinical and Laboratory Committee), CA. Fux, M. Gorgievski, H. Günthard (Chairman of the Scientific Board), D. Haerry (deputy of “Positive Council”), B. Hasse, HH. Hirsch, B. Hirschel, I. Hösli, C. Kahlert, L. Kaiser, O. Keiser, C. Kind, T. Klimkait, H. Kovari, B. Ledergerber, G. Martinetti, B. Martinez de Tejada, K. Metzner, N. Müller, D. Nadal, G. Pantaleo, A. Rauch, S. Regenass, M. Rickenbach (Head of Data Center), C. Rudin (Chairman of the Mother and Child Substudy), P. Schmid, D. Schultze, F. Schöni-Affolter, J. Schüpbach, R. Speck, P. Taffé, P. Tarr, A. Telenti, A. Trkola, P. Vernazza, R. Weber, and S. Yerly.
Received May 25, 2012
Accepted July 31, 2012