Altice and Springer question the rationale for our study1 because the patient population was highly motivated, which they imply meant that adherence and virologic response rates would be high, leaving no room for improvement. In addition, they make the points that the intervention was “untested” and that the chosen sample size seemed arbitrary. We disagree. Our target population was treatment naive and unselected for prior adherence problems because the goal was to forestall nonadherence before it became entrenched. Although risk factors for nonadherence exist, no predictive model has been developed to accurately target individuals destined to be nonadherent, even in patients with a history of illicit drug use. The fact that the proportion of individuals with undetectable viral loads at the completion of our study was not extremely high shows that a margin for improvement existed.
Gross R, Tierney C, Andrade AS, Flexner C, Mildvan D. DAART for Human Immunodeficiency Virus–Infected Patients: Studying Subjects Not at Risk for Nonadherence and Use of Untested Interventions—Reply. Arch Intern Med. 2010;170(1):110. doi:10.1001/archinternmed.2009.460