Exactly what level of adherence to HIV medications is required to maintain virological control?
Dear Dr. Young:
This is a question that has always intrigued me, ever since I started on an effective antiretroviral treatment combination in 1997. Back then we were warned that even missing a single dose of our medications could spell disaster i.e. HIV resistance and subsequent loss of virological control. So I mustered all the self-discipline I could and took my medications as "correctly" as humanly possible and attained virological control (viral load measurements below the limit of quantification using whatever technology at the time) that I have maintained. Recently I undertook a very rigorous audit of my adherence that disclosed that in fact I take about 99 per cent of my doses and completely miss about one per cent in a one-year timeframe. Despite this error and lack of perfection my viral load remains undectable. I was just curious because even with the utmost of care that I bring to the task I still fall short of one hundred per cent perfection. Thank you for any insight you can provide.
Please accept my best regards,
Wayne Toronto, Canada
Response from Dr. Young
Hi Wayne and thanks for posting from Canada.
Perfection might be a goal, but rarely achieved.
You're adherence is exemplary- 99% is excellent and not associated with any decline in viral suppression. I would not be concerned about a 1% missed dose at all.
While we continue to quote a 95% goal (from a ~1999 study), with current medications, it's quite likely that lower levels of adherence continue to provide very good viral suppression.
In my clinic of less-than-perfect patients, loss of viral control has been exceptionally rare, and often the result of complete discontinuation of medications, rather than the inadvertent missed dose. So, worry not.
Be well, BY