Phillips TK, Wilson IB, Brittain K, Zerbe A, Mellins CA, Remien RH, Orrell C, Abrams EJ, Myer L.
J Acquir Immune Defic Syndr. 2018 Nov 5. doi: 10.1097/QAI.0000000000001909. [Epub ahead of print]

INTRODUCTION:

Routine HIV viral load (VL) monitoring is recommended for patients on antiretroviral therapy (ART) but frequent VL testing, required in pregnant and postpartum women, is often not feasible. Self-reported adherence can be valuable, but little is known about its longitudinal characteristics.

METHODS:

We followed women living with HIV from ART initiation in pregnancy through 18 months postpartum in Cape Town, South Africa, with repeated measurement of VL and self-reported adherence using a three-item scale. We used generalized estimating equations (with results presented as odds ratios [OR] with 95% confidence intervals [CI]) to investigate the association between viremia and change in adherence over pairs of consecutive visits.

RESULTS:

Among 2085 visit pairs from 433 women, a decrease in self-reported adherence relative to the previous visit on any of three self-report items, or the combined scale, was associated with VL >50 and >1000 copies/mL. The best performing thresholds to predict VL >50 copies/mL were a single level decrease on the Likert response item “how good a job did you do at taking your HIV medicines in the way that you were supposed to?” (OR 2.08 95% CI 1.48-2.91), and a decrease equivalent to ≥5 missed doses or a one level decrease in score on either of two Likert items (OR 1.34 95% CI 1.06-1.69).

CONCLUSION:

Longitudinal changes in self-reported adherence can help identify patients with viremia. This approach warrants consideration in settings where frequent viral load monitoring or other objective adherence measures are not possible.