Recently published findings indicate that suboptimal adherence to ART is associated with activation of coagulation and enhanced residual inflammation among patients with HIV, even if patients have already achieved virologic suppression.
“Recently, suboptimal ART adherence has emerged as a potential contributor to residual inflammation in [people living with HIV], even if it is sufficient to achieve and sustain plasma viral suppression through conventional assays,” Jose R. Castillo-Mancilla, MD, associate professor of medicine at the University of Colorado Anschutz Medical Campus, and colleagues wrote. “These observations have emphasized the potential biological differences that could exist between complete and suboptimal ART adherence in order to maximize the therapeutic benefit of ART. Whether these associations can also be identified in a large, multinational diverse population remains unknown.”
The researchers performed a retrospective analysis evaluating the relationship of adherence to ART with inflammation and coagulation activation among patients enrolled in the Strategies for Management of ART (SMART) study, a multinational, randomized clinical trial of 5,472 patients with HIV aged 13 years and older. All patients were receiving ART, had completed a questionnaire about adherence and had available measurements of viral load. The analysis focused on patients who had viral loads of less than 200 copies/mL and it was limited to the baseline clinic visit.
Overall, 3,963 patients had a completed adherence questionnaire and available viral load measurement and were taking ART. More than three quarters (77%) were suppressed to less than 200 copies/mL.
Patients who reported suboptimal adherence had 9% higher plasma concentrations of interleukin 6 compared with those who reported 100% adherence (95% CI; 1%-18%), the researchers reported. Similarly, those with suboptimal ART adherence demonstrated 11% higher concentrations of D-dimer (95% CI; 1%-22%).
“We demonstrated that suboptimal ART adherence, even if it results in virologic suppression by conventional clinical assays, is associated with enhanced residual inflammation and activation of coagulation in [people living with HIV] on chronic ART,” the researchers wrote. “These findings replicate previous cohort observations and highlight the importance of optimal and durable ART adherence as a potential factor to improve morbidity and mortality in HIV disease.”
By Andy Polhamus