Trajectories of Antiretroviral Therapy Adherence and Virologic Failure in Women with HIV in the United States

Background:Women with HIV (WHIV) in the United States face many challenges with adherence to antiretroviral therapy (ART), and suboptimal adherence often leads to virologic failure. This study aimed to determine the association between ART adherence trajectories and the risk of virologic failure.Methods:We included WHIV (aged 18 years or older) enrolled in the Women's Interagency HIV Study in the United States from April 2014 to September 2019 who had at least 2 consecutive measurements of HIV RNA and ≥3 measurements of self-reported adherence. Group-based trajectory modeling was used to identify adherence trajectories. Cox proportional hazard ratios were used to measure the association.Main Outcome Measure:Virologic failure was defined as HIV RNA ≥200 copies/mL at 2 consecutive visits.Results:We included 1437 WHIV (median age 49 years). Of all women, 173 (12.0%) experienced virologic failure. Four adherence trajectories were identified, namely "consistently high"(26.3%), "moderate increasing"(9.5%), "moderate decreasing"(30.6%), and "consistently low"(33.5%). Women in the consistently low adherence group consumed alcohol and experienced depression more than other groups. Compared with the "consistently high"trajectory, the risk of virologic failure was higher among women with "consistently low"[adjusted hazard ratio (aHR) 2.8; 95% confidence interval (CI): 1.6 to 4.9; P < 0.001] and "moderate decreasing"adherence trajectories (aHR 1.8; 95% CI: 1.0 to 3.2; P = 0.04), but it was similar to those with "moderate increasing"adherence trajectory (aHR 1.0; 95% CI: 0.4 to 2.5; P = 0.94).Conclusions:Adherence to ART remains a challenge among WHIV. Multilevel behavioral interventions to address poor adherence, alcohol consumption, and depression are needed.