Same-day ART tied to suboptimal 12-month viral suppression

Patients who initiate antiretroviral therapy (ART) on the same day as their HIV diagnosis achieve suboptimal levels of viral load suppression by 12 months, a recent study has found. Such a trend emphasizes the importance of reinforcing treatment adherence among patients.

Researchers performed a retrospective cohort analysis of 746 patients with HIV, of whom 319 (73.3 percent; median age 31 years, 56.8 percent women) initiated ART on the same day as the diagnosis, while 427 (76.9 percent; median age 33 years, 49.3 percent women) started treatment >7 days after. The primary outcome was low viral load at 12 months.

Twelve-month viral suppression was achieved by 73.4 percent of patients in the same-day ART group and by 83.7 percent in the >7-day arm. The resulting adjusted absolute difference of 8.3 percent was statistically significant (p=0.001).

These findings were robust to sensitivity analysis that excluded participants lost to follow-up (p=0.005), included only viral load tests between 4 and 9 months (p=0.005), and applied a complete-case analysis (p<0.001).

Comparing the two arms revealed significant differences in ART adherence. By 6 months, more patients in the >7-day group had good adherence to medication, defined as missing ≤2 doses (81.2 percent vs 73.1 percent). The same was true at 12 months (78.5 percent vs 70.1 percent).

In contrast, poor adherence, defined as missing ≥6 doses, was greater in the same-day group both at 6 months (21.3 percent vs 14.2 percent) and 12 months (26.4 percent vs 18.6 percent).

“The suboptimal viral load status among same-day ART initiators could be explained by various factors. Among these, ART adherence is a key predictor to viral suppression,” the researchers said. “Reinforcing ART adherence counseling to those starting ART on the same-day of HIV diagnosis is necessary.” [J Int AIDS Soc 2018;21:e25112]