• Nonadherence to triple-combination ART is predictive of AIDS progression and death in HIV+ men and women (TuOrB419)
  Authored by R. Hogg, B. Yip, K. Chan, M. O'Shaughnessy, J. Montaner (Canada)

• Low frequency of genotypic resistance markers in therapy-naive HIV+ adolescents (TuPeA3007)
  Authored by C. Wilson, D. Wray, M. St. Clair, C. Vavro (United States)

Nonadherence to triple-combination ART is predictive of AIDS progression and death in HIV+ men and women (TuOrB419)

This oral presentation is from the same group in Vancouver on whose poster I reported yesterday. In this report they described the predictors of death or progression to AIDS in a cohort of 950 (815 men, 135 women). All the patients were taking triple-combination ART with 85% taking a protease inhibitor and 15% an NNRTI. As can be expected the three independent predictors of mortality or progression were a baseline AIDS diagnosis, baseline low CD4 count, and treatment nonadherence. Nonadherence was measured as in the other abstract, namely by a formula dividing the number of months that medications were dispensed by the number of months in the study. Failure to retrieve dispensed medication was considered a marker of nonadherence.

Low frequency of genotypic resistance markers in therapy-naive HIV+ adolescents (TuPeA3007)

In this study adolescents aged 13-18 with HIV infection were enrolled at 15 sites in the USA. Isolates for resistance testing were obtained prior to initiating antiretroviral therapy (ART). All patients had acquired HIV sexually. Of 111 people (34 male, 77 female) only four patients had significant RT-associated mutations (4.37%) and only one had multiple RT-associated mutations. Protease-associated mutations were common, 56/82 (67%) isolates had one or two mutations. Only two isolates had three mutations. No primary resistance mutations of protease were seen. None of the isolates were likely to be associated with clinically significant drug resistance. The authors concluded that genotypic resistance analysis prior to implementation of ART in drug-naive adolescents in the United States seems unwarranted. Whether this has implications for drug-naive adults is unclear, but intriguing.

Lots of material on adherence and nonadherence has already been presented at this conference. We are all struggling to understand why adherence rates are "so low" and what factors are associated.