ICAAC Highlights
PI therapy evaluated for three months
In a study from the University of Pittsburgh Medical Center, David L. Paterson, MD, a research fellow in infectious diseases, and colleagues evaluated adherence with protease inhibitor therapy for a minimum of three months in 45 patients. Seventy-two percent of patients were taking a single protease inhibitor such as nelfinavir, and 28% were taking a combination of saquinavir/ritonavir (Invirase/Norvir).
At baseline, 31% of patients had undetectable viral loads; the median baseline CD4 count was 296, with a range of 29 to 898. Adherence was described as the percentage of doses of a prescribed medication that were actually taken.
At the start of the study, physicians were asked to predict adherence to drug therapy and were blinded to knowledge of adherence findings of the study. Physicians misidentified 33% of nonadherent patients as adherent. They also identified 36% of patients with better than 95% adherence as being poorly adherent.
In addition, poor adherence was correlated with clinical and virologic failure at three months’ follow-up, with 87% of patients having <80% adherence experiencing failure compared to 47% of patients with 80% to 95% adherence and only 10% of patients with >95% adherence.
Factors associated with adherence included depression, psychiatric morbidity, nonwhite race, low income, and active alcoholism. No association was found between adherence and history of intravenous drug use, years of HIV positivity, a history of an opportunistic infection, baseline CD4 or viral load, total number of pills taken each day, or patient belief in the efficacy of highly active antiretroviral therapy (HAART).
Median adherence to drug therapy was 88% for patients on twice-daily regimens and 84% for patients on three-times-daily regimens. There was no one drug that was associated with better adherence than another drug.
". . . MDs poorly predicted adherence of their patients," the researchers conclude. "Modifiable risk factors for poor adherence [such as] untreated psychiatric morbidity and alcoholism should be targeted in programs aimed to enhance adherence to HAART."
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