Baltimore Aims to Halt Spread of Drug-Resistant HIV

Hoping to prevent the spread of drug-resistant strains of HIV, the Baltimore Health Department yesterday announced plans to monitor patients to make sure they take their medications twice a day, every day.

Dr. Peter L. Beilenson, city health commissioner, said the department will initially enroll 200 patients who will receive their drugs either at a van, pharmacy or public health clinic, all in West Baltimore, which has been devastated by AIDS. Health workers will watch the patients swallow all their pills. Patterned after a program of directly observed therapy that has been used successfully to fight TB in Baltimore for more than 20 years, the effort will be the largest of its kind in the United States, Beilenson said. Though he acknowledged that the strategy is risky, Beilenson said aggressive action is needed to get more patients into treatment and prevent the emergence of drug-resistant HIV strains that can result when patients miss doses.

Dr. Robert Redfield, who directs AIDS care at the University of Maryland Medical Center, said Monday that 14 percent of patients diagnosed in the past year have drug-resistant HIV strains. "If we do nothing, we're going to have more drug resistance. Or we can develop alternative mechanisms and try to improve the delivery of care," Redfield said. Key to the program's success, Redfield said, will be enrolling only patients who truly want to go on medication. He warned that patients who miss 5 percent of their pills run a 20 percent chance of failing treatment.

Researchers from the Bloomberg School of Public Health at Johns Hopkins University will evaluate the program, which will be expanded only if it works. Baltimore has about 6,000 residents with AIDS. Most of the program's $120,000 cost will go toward salaries and the purchase of a van. A state program that offers AIDS medications to low- and middle-income patients will pay for the drugs.

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