• Poster 73: Non-adherence to Triple Combination Is Predictive of AIDS Progression and Death in HIV-Positive Men and Women (Authored by R.S. Hogg, B. Yip, K. Chan, M.V. O'Shaughnessy, and J.S.G. Montaner: British Columbia Center for Excellence in HIV AIDS, Vancouver, Canada)
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• Poster 74: Application and Outcome of Two Strategies to Increase HIV Medication Adherence: Life Steps and Medication (Authored by S.A. Safren, M.W. Otto, J.L. Worth, W.A. Johnson, S. Boswell and K. Mayer: Massachusetts General Hospital and Harvard Medical School and Fenway Community Health, Boston, MA)
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Poster 73: Non-adherence to Triple Combination Is Predictive of AIDS Progression and Death in HIV-Positive Men and Women

It is already well established that non-adherence to antiretroviral therapy leads to a lower likelihood of virologic suppression. In this Vancouver study of drug dispensing data from a government-funded medication assistance program, the clinical consequences of non-adherence are described.

A total of 950 subjects were studied. The analysis included HIV-infected, drug-naive patients starting triple antiretroviral therapy between August 1996 and December 1998. The primary endpoints were death and an AIDS-defining illness. Adherence was measured by dividing the number of months of documented prescriptions dispensed by the number of months of follow-up in the first year of antiretroviral therapy.

In a multivariate model, mortality was independently associated with non-adherence to therapy and a lower CD4 cell count. The likelihood of death and/or AIDS was 1.17 times higher per 10% decline in adherence.

The important finding in this study is that it links the behavior of non-adherence with a clinical outcome, not just a viral or immunologic laboratory marker. It helps us remember that when we provide support for our patient's ability to take their medicines faithfully that we are not merely helping them achieve an undetectable viral load.

Poster 74: Application and Outcome of Two Strategies to Increase HIV Medication Adherence: Life Steps and Medication Monitoring

Steve Safren and colleagues from Massachusetts General Hospital and Fenway Community Health Center describe their results using two different strategies to improve patient adherence. In the first of these -- called Life Steps -- patients are asked to review eleven different aspects of taking medications appropriately, including cues for remembering, communicating with providers about the medications, getting to appointments, filling the prescription, and several others. In the second strategy, a more simple process of medication monitoring was used, which involved an adherence questionnaire as well as a daily diary to record both the number of pills prescribed and the number taken.

Patients who were changing or starting therapy as well as those with known problems of medication adherence were studied. Out of the total of 84 patients, both the Life Steps and the medication monitoring strategy improved adherence to >90% of medications taken after 12 weeks of the intervention, with a better effect seen from the Life Steps approach in the patients with a history of medication non-compliance.

Safren et al. concluded that these relatively simple interventions can have a major impact on medication adherence, and note that both strategies can be followed by a wide variety of health care providers. Whether these or other similar approaches will prove durable beyond three months remains to be determined.