Adherence, sexual risk, and viral load in HIV-infected women prescribed antiretroviral therapy

Abstract

Abstract The purpose of this study was to determine if there was a connection between adherence to antiretroviral therapy (ART) and use of risk reduction behaviors (RRB) in HIV-infected women who were prescribed antiretroviral therapy. The sample consisted of 193 predominately African American women with an average age of 44 who had been on ARV for approximately 9 years and had low annual incomes. All women were participating in a behavioral clinical trial focused on these dual outcomes. Using a risk index developed for this study, we examined the relationship of a composite of risk behaviors to electronically measured and self-reported adherence over the approximately 13-month study period. Women were categorized based on levels of adherence and risky behaviors, and we sought to determine if these classifications were associated with clinical outcomes of HIV viral load and CD4 counts. High levels of adherence were correlated with low risk behaviors (abstinence, consistent use of condoms, etc.). Those classified as high adherence and low-risk behavior (HALR) as well as those classified as high adherence and high-risk behavior (HAHR) had lower mean viral loads and higher CD4 counts than those in the other categories. Women in the low adherence and high-risk category (LAHR) had detectable viral loads and the lowest CD4 counts and are at higher risk for transmitting HIV to partners and unborn children. Our findings underscore the importance of addressing adherence to both ART and RRB in HIV clinical settings to improve clinical outcomes and reduce HIV transmission.

Figures

FIG. 1.

Adjusted mean viral load (log) by time period of assessment and by adherence/risk group classification. HALR, high adherence, low risk (n=51); HAHR, high adherence, high risk (n=37); LALR, low adherence, low risk (n=40); LAHR, low adherence, high risk (n=56). Bars with the same letters on top differ significantly with each other at p<0.05 for the time comparisons and p<0.001 for the group comparisons. Covariates included intervention group, intervention attendance, age at baseline, and number of years HIV-positive.