February 7, 2001
More on the incredible importance of adherence -- Margaret Fischl presented more data on her study looking at the impact of directly observed therapy on virologic outcomes. This study was an expansion of the noteworthy data she presented at a poster at last year's meeting. She examined the virologic outcomes in 50 patients beginning HAART in prison under direct observation (DOT group) and 50 patients beginning HAART in an outpatient research clinic. The DOT group was more likely men, black, non-Hispanic, IDUs, and they had a lower baseline CD4 count (246 versus 329 cells/mm3 and higher RNA level (5.6 vs. 5.3 log). Despite those factors, the week 80 rates of viral level <400 copies/mL were 95% in the DOT group versus 75% in the clinical research group. This is a very important observation, which underscores the incredible importance of high-level adherence. The success rates in the clinical research group were impressive enough and likely are much higher than what would be observed in a regular non-research clinic. The almost 100% success rates on the DOT group suggests to me that less emphasis should be placed on comparing different HAART regimens and more emphasis should be placed on how to use the available regimens in a more effective and supervised manner.