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HIV-Infected Patients Receiving Lopinavir/Ritonavir-Based Antiretroviral Therapy Achieve High Rates of Virologic Suppression Despite Adherence Rates Less Than 95%

Shuter, Jonathan MD*†; Sarlo, Julie A PA*; Kanmaz, Tina J PharmD; Rode, Richard A PhD§; Zingman, Barry S MD*†∥

JAIDS Journal of Acquired Immune Deficiency Syndromes: May 1st, 2007 - Volume 45 - Issue 1 - p 4-8
doi: 10.1097/QAI.0b013e318050d8c2
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Background: The observation that extremely high levels of medication adherence are required to achieve complete virologic suppression is based largely on studies of treatment-experienced patients receiving HIV protease inhibitor (PI)-based therapy without ritonavir boosting. This study aims to define the level of adherence needed to achieve virologic suppression in patients receiving boosted PI-based highly active antiretroviral therapy (HAART) with lopinavir/ritonavir.

Methods: HIV-infected adults receiving a regimen containing lopinavir/ritonavir were recruited into a prospective, observational study of the relation between adherence to lopinavir/ritonavir and virologic outcomes. Adherence was measured using the Medication Event Monitoring System (MEMS; Aardex, Union City, CA). HIV-1 viral load (VL) was measured at week 24.

Results: The final study population contained 64 subjects. Eighty percent had AIDS, 97% received lopinavir/ritonavir before enrollment, and most had more than 7 years of HAART experience. Mean adherence overall was 73%. Eighty percent and 59% achieved a VL <400 copies/mL and a VL <75 copies/mL, respectively. Mean adherence was 75% in those achieving a VL <75 copies/mL. High rates of virologic suppression were observed in all adherence quartiles, including the lowest quartile (range of adherence: 23.5%-53.3%).

Conclusions: Moderate levels of adherence can lead to virologic suppression in most patients taking lopinavir/ritonavir-based HAART.

© 2007 Lippincott Williams & Wilkins, Inc.