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Winter 2007 Newsletter / Volume 8, Issue 2

HIV Treatment News

Medical Care

"For antiretroviral therapy, the 95% adherence 'threshold' is based on nucl[e]oside-exposed patients who are receiving partially suppressive, unboosted protease inhibitor regimens" (p. 939), according to Bangsberg (2006), who monitored 110 participants in a longitudinal study of homeless and marginally housed adults living with HIV in San Francisco. Among these study participants, 56 were receiving protease inhibitors and 54 were receiving non-nucleoside reverse-transcriptase inhibitors (NNRTIs; e.g., nevirapine [NVP or Viramune®] or efavirenz [EFV or Sustiva®]). "Using unannounced pill counts and electronic medication monitoring," Bangsberg found that "viral suppression is common with a 54%-100% mean adherence level to [NNRTI] regimens" (p. 939). Bangsberg takes pains to specify that, "[a]lthough viral suppression may be possible with moderate levels of adherence, the probability of viral suppression and, more importantly, reduced disease progression and mortality improves with every increase in adherence level. As such, these data do not alter the goal to achieve the highest level of adherence possible; rather, they provide evidence that patients with moderate levels of adherence may also do well while receiving potent antiretroviral therapy" (p. 941).  

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