No Evidence of an Association Between Transient HIV Viremia (Blips) and Lower Adherence to the Antiretroviral Medication Regimen

Published in: Journal of Infectious Diseases, v. 189, no. 8, Apr. 15, 2004, p. 1487-1496

Posted on RAND.org on January 01, 2004

by Loren G. Miller, Carol E. Golin, Honghu H. Liu, Ron D. Hays, Jenna Hua, Neil S. Wenger, Andrew H. Kaplan

Read More

Access further information on this document at www.journals.uchicago.edu

This article was published outside of RAND. The full text of the article can be found at the link above.

BACKGROUND: Transient human immunodeficiency virus (HIV) viremia, a common phenomenon among patients taking antiretroviral therapy, is often attributed to lapses in adherence to the medication regimen. The authors investigated this relationship in a prospective observational cohort of 128 patients initiating a new regimen. METHODS: A case of transient viremia was defined as an HIV RNA level of 40-1000 copies/mL (blip) sandwiched between 2 months of HIV RNA levels <40 copies/mL (pre and post). Adherence was most often measured with a composite adherence score (CAS), which is primarily based on electronically measured adherence. Case subjects' adherence and dose-timing was compared with (1) that of other patients (control subjects), who had undetectable virus loads for 3 consecutive months, and (2) that during periods of sustained undetectable virus loads among the case subjects themselves, if available. RESULTS: Among the 28 case subjects, mean CAS-measured adherence did not decrease before transient viremia; adherence during the pre, blip, and post periods were 86%, 84%, and 80%, respectively. Control subjects had lower adherence levels during the corresponding 3 months (77%, 79%, and 75%, respectively; P = .046). Among the 19 patients able to serve as their own controls, CAS-measured adherence was higher during the period of transient viremia than during control periods (P = .01). Similar relationships were found when comparing only electronically measured adherence on a week-wise basis. There were no significant differences in dose-timing error between case subjects and control subjects. CONCLUSIONS: The authors found no evidence that transient HIV viremia is associated with decreases in adherence or differences in dose-timing. Other etiologies for transient viremia should be evaluated.

This report is part of the RAND Corporation external publication series. Many RAND studies are published in peer-reviewed scholarly journals, as chapters in commercial books, or as documents published by other organizations.

The RAND Corporation is a nonprofit institution that helps improve policy and decisionmaking through research and analysis. RAND's publications do not necessarily reflect the opinions of its research clients and sponsors.