Determinants of Sustained Virological Suppression in Indigent, HIV-Infected Patients: Is Single Protease Inhibitor-Based Antiretroviral Therapy Truly Highly Active?

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Abstract
Background: Effective virological suppression with HAART is dependent on strict adherence to therapy. Compliance with therapy is influenced by clinical and psychosocial factors. Method: We performed a retrospective study investigating determinants of effective virological suppression, defined as 3, and 53,000, respectively. Thirty-nine percent had AIDS, 20% had cocaine-positive drug screens, and 64% were antiretroviral naïve. Two hundred and sixty-seven patients were started on HAART. Thirty-four percent showed virological suppression. Results: In multivariate analysis, adherence to HAART, care by experienced primary provider, baseline VL 35 years, and no active substance use were associated with virological suppression. Rates of virological suppression with HAART are unacceptably low in this urban indigent population. Conclusion: Low rates of virological suppression are primarily due to lack of adherence rather than late utilization of care among ethnic minorities. Single protease-inhibitor-based antiretroviral therapy does not appear to be highly active in this patient population.