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Importance of Dose Timing to Achieving Undetectable Viral Loads

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Abstract

Little is known about the importance of dose timing to successful antiretroviral therapy (ART). In a cohort comprised of Chinese HIV/AIDS patients, we measured adherence among subjects for 6 months using three methods in parallel: self-report using a visual analog scale (SR-VAS), pill count, and electronic drug monitors (EDM). We calculated two adherence metrics using the EDM data. The first metric used the proportion of doses taken; the second metric credited doses as adherent only if taken within a 1-h window of a pre-specified dose time (EDM ‘proportion taken within dose time’). Of the adherence measures, EDM had the strongest associations with viral suppression. Of the two EDM metrics, incorporating dose timing had a stronger association with viral suppression. We conclude that dose timing is also an important determinant of successful ART, and should be considered as an additional dimension to overall adherence.

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Acknowledgments

This work was supported by a cooperative agreement (GHS-A-00-03-00030-00) between Boston University and the Office of Health and Nutrition of the United States Agency for International Development (USAID), with additional support from the World Health Organization (WHO) and CDC-GAP/China. Dr. Gill’s work was supported by NIH/NIAID K23 AI 62208. We wish to thank Mary Jordan and Lois Bradshaw at USAID, Jonathan Simon, Donald Thea, Deirdre Pierotti at Boston University, our Boston-based project managers Mini Singh and Anna Knapp, our Chinabased field managers James Chen, Guo Jinhua, and Matt Bobo, Cheng Feng at FHI, Ray Yip at CDC-GAP, and Connie Osborne at the WHO-Beijing office.

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Authors and Affiliations

  1. Center for International Health and Development, Boston University of Public Health, 801 Massachusetts Avenue, Crosstown Center, 3rd Floor, Boston, MA, 02118, USA

    Christopher J. Gill, Lora L. Sabin, Davidson H. Hamer, Tao Li, Wan-Ju Wu & Mary Bachman DeSilva

  2. Infectious Diseases Section, Department of Medicine, Boston University School of Medicine, Boston, MA, USA

    Christopher J. Gill & Davidson H. Hamer

  3. Department of Sexually Transmitted Diseases and Dermatology, Ditan Hospital, Beijing, China

    Xu Keyi

  4. Department of Sexually Transmitted Diseases and Dermatology, Dali Second People’s Hospital, Dali, China

    Zhang Jianbo

  5. Institute for Clinical Research and Health Policy Studies, Tufts-New England Medical Center, Boston, MA, USA

    Ira B. Wilson

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  1. Christopher J. Gill
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  2. Lora L. Sabin
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  3. Davidson H. Hamer
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  4. Xu Keyi
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  5. Zhang Jianbo
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  6. Tao Li
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  7. Wan-Ju Wu
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  8. Ira B. Wilson
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  9. Mary Bachman DeSilva
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Correspondence to Christopher J. Gill.

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Gill, C.J., Sabin, L.L., Hamer, D.H. et al. Importance of Dose Timing to Achieving Undetectable Viral Loads. AIDS Behav 14, 785–793 (2010). https://doi.org/10.1007/s10461-009-9555-9

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  • DOI: https://doi.org/10.1007/s10461-009-9555-9

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