AIDSImpact.com:: - Santa Fe, USA 2011

Abstract #274 - Predicting viral suppression nine months after ARV initiation: no holy grail?
Authors: Presenting Author: Dr Jane Simoni - University of Washington
Additional Authors: Mr. David Huh, Ms. Samantha Yard,
Aim: Antiretroviral (ARV) therapy revolutionized AIDS care and transformed HIV from a nearly fatal illness to a chronic, manageable disease. Yet, not every individual responds to ARV treatment. Knowing at initiation which patients might be at greatest risk for failure to achieve viral suppression would represent a “holy grail” for providers, enabling them to target those most in need and tailor their care appropriately.
Method / Issue: In a secondary analysis based on data from a RCT of peer and pager support to enhance antiretroviral therapy, we examined multiple possible predictors (7 sociodemographic and 14 socio-behavioral) of HIV-1 RNA viral load, operationalized as a log-transformed continuous variable. Participants were 224 patients (76% male; 47% White, 30% Black, 11% Hispanic) receiving primary care at an outpatient HIV clinic in Seattle, WA who were initiating or altering their ARV regimen. Univariate analyses first were run, and then a “multivariate” analysis controlling for any variable that was significant at p < . 10 in the univariate analyses. Previous ARV experience (ARV naïve or not at baseline) was controlled for in all models. A significant result meant that the variable prospectively predicted differences in viral load trajectory.
Results / Comments: Univariate analyses of possible baseline predictors indicated that more years diagnosed, poorer physical health, and lower medication self-efficacy were associated (p < .10) with failure to achieve viral suppression 9 months later; however, none remained significant in the multivariate analysis.
Discussion: Results indicate there is no simple baseline indicator beyond previous ARV experience capable of predicting which patients will have difficult achieving viral suppression 9 months later. Therefore, there is no reason to suspect any single group will benefit from ARVs to a greater degree.
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