ART refill histories can help predict future virologic failure
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Researchers used refill histories to measure ART adherence among people with HIV and evaluated its impact on the potential for future virologic failure.
They found that lower adherence to ART was predictive of future virologic failure when a patients’ percentage of days covered — as measured through their medication refills — was 52% or lower.
Darryl Sokpa, a PharmD/MBA candidate at the University of Nebraska Medical Center, said past studies have evaluated other metrics to measure ART adherence, including dried blood spots.
“While each of these adherence metrics has its own set of positive and negative attributes, percentage of days covered (PDC) is arguably the easiest to collect — encompassing all antiretrovirals — and can be used in real-time clinical decision-making,” Sokpa told Healio. “We wanted to evaluate the use of PDC as a measure to assess future viral failure and to identify an associated PDC threshold level.”
For the study, they retrospectively evaluated participants from a Midwestern U.S. HIV clinic from 2018 to 2020, looking at their refill histories and last HIV RNA for each study year. They quantified the refill histories as PDC and defined viral failure (VF) as HIV RNA greater than 200 copies/mL.
Overall, the study demonstrated that among the 1,923 matched pairs included in the study, a PDC less than or equal to 52% was identified as a threshold that was predictive of future HIV viremia.
Additionally, the researchers noted subgroups with higher odds of a PDC below 52%, including people who are Black, experiencing homelessness, using government-based insurance or no insurance, and/or not in a committed relationship.
“Our findings suggest PDC may be a useful clinical tool to identify patients at risk of future viral failure,” Sokpa said. “Additionally, our results may help clinicians better understand adherence trends to make better real-time clinical decisions and identify patients [who] may benefit from adherence support interventions and/or resistance testing."
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