Figure 1.

Interpreting concomitant HIV viral suppression and drug concentrations in PWH. The green and red squares represent expected clinical scenarios in patients on ART in whom the pharmacologic adherence measures (i.e., drug concentrations) match the clinical outcome (i.e., viral suppression or viremia) and in whom positive feedback (green) or the identification of an adherence barrier (red) are indicated. The black square represents a mismatch scenario where HIV resistance testing is indicated in the setting of high viremia despite high drug concentrations that are expected to be suppressive. The yellow square represents a mismatch scenario in a patient who is virologically suppressed despite having low drug concentrations and in whom an adverse outcome (i.e., viremia, HIV transmission, heightened inflammation) might be imminent, requiring immediate counseling intervention. Adapted with permission from Spinelli et al.¹

ART, antiretroviral therapy; PWH, persons with HIV.