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The Body Covers: The XIII International AIDS Conference
Patient Adherence to Antiretroviral Therapies -- I

Coverage provided by Alvan Fisher, M.D.

July 10, 2000


This article is part of TheBody.com's archive. Because it contains information that may no longer be accurate, this article should only be considered a historical document.

    • Patient adherence to highly active anti-retroviral therapy for HIV-1 infection in a nationwide cohort study in the Netherlands (MoPpD1055)
      Authored by P. Nieuwkerk, D. Burger, P. Hugen, R. Aarnoutse, R. Van Heeswijk, A. Veldkamp, R. Hoetelmans, M. Sprangers (Netherlands); ATHENA Project

    • Virologic success rates drop off sharply with decreasing levels of adherence to antiretroviral therapy (MoPpD1056)
      Authored by V. Montessori, E. Wood, S. Low Beer, B. Yip, M. O'Shaughnessy, R. Hogg, J. Montaner (Canada)

    • Women and antiretroviral treatment: gender differences in uptake and attitude (MoPpD1057)
      Authored by K. McDonald, M. Bartos, R. De Visser, J. Grierson (Australia)

    • Recombinant erythropoietin (r-HuEPO) for treatment of anemia in HIV-infected pregnant women (MoPeB2229)
      Authored by A.R. Troncoso, A. Dos Santos, H. Gulotta, R. Iacono, E. Poskus, P. Saul, M. Tommasi, K. Semorile, E. Loiza, M. Berdion, J. Crespi (Argentina)


    Patient adherence to highly active anti-retroviral therapy for HIV-1 infection in a nationwide cohort study in the Netherlands (MoPpD1055)

    The researchers attempted to correlate adherence and a measure of drug exposure. Their adherence tool was a self-report questionnaire that they gave to 224 Dutch patients who were also having a pharmacokinetic analysis performed. The latter was done to assess drug exposure using a mathematical model dividing the measured plasma concentration of a taken protease inhibitor by its "expected concentration" based on known PK values. The take home message was that the adherence, as self-reported, was not very good: only 53% reported taking all meds, on time, and with the necessary food requirements. As can be guessed, those not adherent had lower drug exposure and were less likely to suppress viral load. The problem with this report is their measurement of drug exposure relies on parameters that may not be relevant in an individual patient.


    Virologic success rates drop off sharply with decreasing levels of adherence to antiretroviral therapy (MoPpD1056)

    This poster from the University of British Columbia in Vancouver demonstrated poor overall adherence and a correlation of poor adherence with poor virologic outcome. They measured adherence in a unique way using prescriptions dispensed as the major parameter. All patients at the center received their prescription free-of-charge at the center's pharmacy, in order to track whether patients were at least picking up their prescriptions. The authors could not measure whether patients were taking the drugs once dispensed -- leading to a possible overestimation of adherence. The adherence rate as so defined of 504 patients, all prescribed two NRTI and one protease inhibitor (87.5%) or two NRTI and one NNRTI (12.5%) were 57%. They then correlated the level of adherence with virological response:


    Percent AdherentPercent Achieved <500 Copies
    (On at Least Two Time Points)
    <70%12%
    70-80%24%
    80-90%47%
    90-95%64%
    95-100%84%


    The conclusion is that virologic success was dependent on high levels of adherence.


    Women and antiretroviral treatment: gender differences in uptake and attitude (MoPpD1057)

    OI prophylaxis was also assessed. A similar discrepancy was found for 1997 but not for 1999:


    199737% female vs. 56% male (statistically significant)
    199933% female vs. 33% male (not statistically significant)


    They concluded that women seem to be using ART ("uptake") less than men, but state of disease recommendations (such as OI prophylaxis) seems to be equally accepted.


    Recombinant erythropoietin (r-HuEPO) for treatment of anemia in HIV-infected pregnant women (MoPeB2229)

    In this study, recombinant human erythropoietin (r-HuEPO) was given to anemic pregnant women who had been receiving zidovudine/AZT (ZDV). Severe anemia can necessitate ZDV-based treatment interruption among this population, and must be treated in an effort to increase hemoglobin (Hb) and hemocrit (Ht) levels in the blood.

    The study compared a group of 37 women who were treated with r-HuEPO plus iron and folic acid with a control group of 37 untreated women who received only iron and folic acid. All participants were at least 16 weeks pregnant and were receiving ZDV-based antiretroviral therapy. Hb and Ht levels were comparable in both groups prior to treatment. Median Hb levels in the treated group and the control group were 7.24 g/dL ± 1.12 SD and 7.45 g/dL ±0.93 SD, respectively. Median Ht levels in the treated group and the control group were 21.8% ± 3.38 SD and 23.23% ± 3.03 SD, respectively.

    The results of the study are summarized in the following table:

      Treated Group
    pre-treatment    		 Treated Group
    post-treatment    		 Control Group
    pre-treatment    		 Control Group
    post-treatment
    Median Hb level 7.24 g/dL ± 1.12 SD 11.0 g/dL ± 1.79 SD 7.45 g/dL ± 0.93 SD 8.80 g/dL ± 1.69 SD
    Median Ht level 21.8% ± 3.38 SD 32.9% ± 5.32 SD 23.23% ± 3.03 SD 27.90% ± 5.21 SD

    The results show increases in Hb and Ht values in both the treated group and the control group, but those women treated with r-HuEPO showed significantly greater increases than those in the control group.

    The authors of the study clearly support use of r-HuEPO as a safe and effective treatment to combat anemia in pregnant women. In addition to the significant increases in Hb and Ht with r-HuEPO, no severe adverse effects were noted in the mothers or the infants.


This article is part of TheBody.com's archive. Because it contains information that may no longer be accurate, this article should only be considered a historical document.

See Also
More on HIV Treatment Adherence

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Please note: Knowledge about HIV changes rapidly. Note the date of this summary's publication, and before treating patients or employing any therapies described in these materials, verify all information independently. If you are a patient, please consult a doctor or other medical professional before acting on any of the information presented in this summary. For a complete listing of our most recent conference coverage, click here.

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