Open AccessModeling the HIV Protease Inhibitor Adherence–Resistance Curve by Use of Empirically Derived Estimates
Author(s) -
David R. Bangsberg,
Travis C. Porco,
Christopher R. Kagay,
Edwin D. Charlebois,
Steven G. Deeks,
David Guzman,
Richard A. Clark,
Andrew R. Moss
Publication year - 2004
Publication title -
the journal of infectious diseases
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 2.69
H-Index - 252
eISSN - 1537-6613
pISSN - 0022-1899
DOI - 10.1086/420790
Subject(s) - drug resistance , protease inhibitor (pharmacology) , regimen , human immunodeficiency virus (hiv) , viral load , population , drug , protease , medicine , potency , hiv drug resistance , hiv 1 protease , immunology , virology , pharmacology , antiretroviral therapy , biology , genetics , enzyme , in vitro , biochemistry , environmental health
The standard view postulates a bell-shaped relationship between adherence to therapy and development of drug-resistant human immunodeficiency virus (HIV), with a resistance peak at a moderate level of adherence. This relationship has not been confirmed empirically. We statistically modeled the relationship between adherence and development of drug resistance, using empirically defined relationships of the rate of viral suppression and drug-resistance-mutation accumulation derived from patients receiving protease-inhibitor-based therapy. We found that the maximal rate of drug resistance occurs at 87% adherence and declines modestly at 100% adherence. Higher levels of viral suppression at 100% adherence (a marker of greater regimen potency) progressively reduce the overall population rate of drug resistance and shift the peak resistance rate to lower levels of adherence.
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