A Combination of Poor Adherence and a Low Baseline Susceptibility Score is Highly Predictive for HAART Failure

• Published in: Antiviral chemistry & chemotherapy Vol. 13; no. 4; pp. 231 - 240
• Main Authors: Van Vaerenbergh, Kristien, De Geest, Sabina, Derdelinckx, Inge, Bobbaers, Herman, Carbonez, An, Deschamps, Ann, De Graeve, Veerle, De Saar, Veerle, Ceunen, Helga, De Smet, Koen, Maes, Bart, Peetermans, Willy, Schrooten, Yoeri, Desmyter, Jan, De Clercq, Erik, Van Ranst, Marc, Van Wijngaerden, Eric, Vandamme, Anne-Mieke
• Format: Journal Article
• Language: English
• Published: London, England SAGE Publications 01.08.2002; International Medical Press; Sage Publications Ltd
• Subjects: Adult; Algorithms; Antibiotics. Antiinfectious agents. Antiparasitic agents; Antiretroviral drugs; Antiretroviral Therapy, Highly Active; Antiviral agents; Biological and medical sciences; CD4 Lymphocyte Count; Disease resistance; Drug Resistance, Viral - genetics; Electronics; Genotype; Genotypes; Highly active antiretroviral therapy; HIV; HIV Infections - drug therapy; HIV Infections - immunology; HIV Infections - virology; HIV-1 - genetics; Human immunodeficiency virus; Humans; Logistic Models; Male; Medical sciences; Middle Aged; Patient Compliance; Pharmacology. Drug treatments; Predictive Value of Tests; RNA, Viral - analysis; Treatment Failure; Treatment Refusal; Viral Load; HIV-1; genotypic drug resistance; viral load; adherence; HAART; Human; Treatment resistance; HIV-1 virus; Treatment efficiency; Retroviridae; Genotype; Review; Lentivirus; Adhesion; Virus; Drug compliance; Surveillance; Antiviral; Human immunodeficiency virus; Predictive factor; Therapeutic protocol; Viral load
• ISSN: 2040-2066; 0956-3202; 2040-2066
• DOI: 10.1177/095632020201300404

The relationship between adherence, virological response to highly active antiretroviral therapy (HAART) and the presence and development of genotypic resistance was assessed in 41 HIV-infected patients on HAART. Four adherence parameters (drug taking adherence, dosing adherence, timing adherence and drug holidays) were scored prospectively using electronic event monitoring. Genotypic resistance at baseline and after therapy failure was scored retrospectively and a genotype-based susceptibility score was calculated. Overall median adherence rates were high. All adherence parameters were better in virological responders (n=31) compared to non-responders (n=10), drug taking adherence and number of drug holidays being significantly different. Responders had a significantly higher susceptibility score. Stepwise logistic regression showed that the number of drug holidays and a low susceptibility score were highly predictive for therapy failure. Despite the presence of a limited number of baseline resistance mutations, perfectly adherent patients can control virus replication for a prolonged period.