If you’re HIV-poz, what’s essential to achieving viral suppression?

     The answer:  adherence to antiretroviral (ARV) therapy.  This faithfulness and fidelity about taking your HIV meds on the regular put you on the righteous road toward becoming undetectable.  And that, my friends, is the ultimate destination—to NOT transmit the virus to your sexual partners.

     Unfortunately, however, social factors are undermining adherence to ARV therapy among persons living with HIV in the United States.  This results in drug resistance that compromises future treatment options. 

     Some of these significant and sometimes insurmountable societal challenges include unemployment, loss/lack of medical insurance, mental instability (anxiety, depression, destructive behavior, suicide), as well as the “gift that keeps on giving:” racism and racial inequity.   And to make matters even worse, the COVID-19 pandemic–that’s spreading like uncontained wildfires ravaging the world, particularly the U.S.—is a potent accelerant.

     Overall, the proportion of the HIV population on ARVs who adhere to its daily regimen at an optimal rate remains quite low, according to MPR, Monthly Prescribing Reference.  A multispecialty drug information resource for healthcare professionals, MPR offers concise prescribing information, as well as news and features on cutting-edge topics in harmacotherapy.

     According to Poz.com, “Looking to estimate the rates of adherence to ARVs as well as the prevalence of drug resistance among people with HIV, investigators analyzed data from the Integrated Dataverse from the Symphony Health database and the Monogram/Lab Corp Database.  The period they analyzed ran from January 1, 2015, to September 30, 2017.  Published in AIDS and Behavior, this study measured adherence based on the percentage of days within a 12-month period that was covered by prescriptions filled by each individual.

     “On average, 72% of the days in that period were covered by ARVs among the nearly 170,000 people included in the analysis.  Forty-five percent of the study cohort members were considered to have poor adherence because less than 80% of the days in the year were covered by ARVs, while 30% had suboptimal adherence (80% to just under 95% of days were covered) and just 25% had optimal adherence (95% or more days were covered).” 

     The study examined nearly 96,000 samples provided for drug resistance testing and discovered that 31% showed evidence of resistance to ARVs.  “From state to state, the prevalence of drug resistance ranged from 20% to 54%,” according to Poz.com.  “ Out of the five states that had the highest prevalence of drug resistance, three of them had a rate of poor adherence to ARVs greater than 40%.  In Southern states, 50% of the individuals had poor adherence to ARVs.”

     The authors of the study emphasized that social determinants of health should be taken into consideration when selecting an ARV regimen.  They added that efforts must be made to improve adherence–thereby preventing the development of resistance.

     They concluded, “’This study is one of the first in the U.S. to provide a comprehensive understanding of the current status of adherence to ART (antiretroviral therapy), the prevalence of resistance to HIV drugs, social determinants of health that could be associated with poor or suboptimal adherence and ART resistance’.”

     So, adhere to the bottom line:  If you’re HIV-poz, keep poppin’ your ARV meds—and “make sho’ to do it to it on the regular.”  Safeguard your health!  And that of your intimate partners.