• Poster 69: Adherence and Viral Load in HIV-Infected Drug Users: Comparison of Self-Report and Medication Event Monitors (MEMS) (Authored by J. Arnsten, P. Demas, M. Gourevitch, D. Buono, H. Farzadegan,and E. Schoenbaum. Montefiore Med. Ctr., Bronx, NY and Johns Hopkins School of Hygiene and Publ. Hlth., Baltimore, MD)
  Click here to view the original abstract

• Poster 71: Impact of Directly Observed Therapy on Outcomes in HIV Clinical Trials (Authored by M. Fischl, A. Rodriguez, E. Scerpella, R. Monroig, L. Thompson, and D. Rechtine. Univ. of Miami and Dept. of Corrections, Orlando, FL)
  Click here to view the original abstract

Adherence, Adherence, Adherence

A group of posters were presented that again emphasized the critical relationship between adherence (how many pills you miss) and decreases in viral load, as well as the need to directly measure adherence, rather than rely on self-reporting by people on antiretroviral therapy.

Dr. Margaret Fischl, from the University of Miami, presented a poster comparing people on several ACTG trials who were in jail, where they were directly observed taking all of their prescribed pills (directly observed therapy , or DOT), to people who were on the same ACTG studies, but not in jail (see: poster 71). At 48 weeks, 80% of the people in jail had HIV RNA <400, compared to only 50% of the people who were not in jail, and responsible for their own medications. While there certainly are other factors which may have contributed to this difference -- such as possible use of street drugs, etc. -- it is nevertheless an impressive difference.

Curiously, the incidence of side effects, or toxicity, was higher in the people not in jail. While it would seem logical to expect that the more of their pills a person took, the more side effects they might have, Dr. Fischl commented that people who have better control of HIV replication might have fewer side effects, another possible, and unexpected benefit, of improved adherence.

Another poster compared patient self-reports of missed doses, to data kept by pill bottle caps which have a computer chip that keeps a record of how often the pill bottle is really opened. All of the people in this trial were current or former injection drug users, and all were on methadone. While people reported taking 81% of their prescribed doses, the pill cap data found they actually only took 56% of the pills (see: poster 69). Of interest was that adherence seemed to remain the same over time -- meaning that people who were adherent to their regimens early on, stayed so. The researchers did not ask about cocaine use, which in other studies has been a major deterrent to adherence. They are also planning to do HIV drug resistance tests to determine if resistance developed more often in people who were less adherent, accounting for the differences in suppression of HIV RNA observed. Also, the poster correlated viral load suppression with adherence.

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.