To: margie who wrote (2939 ) 11/21/1997 8:10:00 PM From: JOHN W. Respond to of 6136
Adherence To HIV Therapy Predicts Virologic Control WASHINGTON, Nov 21 (Reuters) - Adherence to HIV antiretroviral drug combination therapy is an important predictor of virologic response in a clinical setting, Dr. Margaret Chesney, of the University of California at San Francisco, said yesterday at Adherence to New HIV Therapies, a research conference sponsored by the National Institutes of Health. In January and February 1997, Dr. Chesney, along with colleagues Dr. Rick Hecht and others, surveyed 380 HIV-positive patients at San Francisco General Hospital. Of those, 134 were on protease inhibitors. Dr. Chesney and colleagues measured the self-reported adherence to the protease inhibitor regimens over a three-day period in that group. Dr. Chesney reported that 12% of the patients skipped at least 1 dose "yesterday," 11% "the day before," and 13% "the day before that." A total of 30% missed at least one dose in the previous three days. There is a link between self-reported skipped doses and viral loads, Dr. Chesney commented. "The people who took 80% or more of their medications had a lower level of viral load than patients who reported taking less than 80% of their doses," she said. The relationship between nonadherence and detectable viremia was statistically significant. The odds ratio for detectable viremia non-adherence relative to adherence was 4.7, Dr. Chesney reported. When asked why they missed their doses, 43% of the patients said that they forgot, 36% slept through the time they were supposed to take their dose, 32% were away from home, 27% experienced a change in routine, 22% were too busy, 11% felt too sick, and 9% were too depressed. Of the 143 patients studied, 89% were men and 63% were white. There are problems with self-reported adherence, such as overestimating adherence and an individual's ability to recall regime behavior, said Dr. Jackie Dunbar-Jacobs of the University of Pittsburgh. Generally, "individuals have good recall for regimen behavior for the last few days. If it's more than 3 to 5 days ago, there is little memory, and people overestimate their adherence to medication, based on their recent regimen," Dr. Dunbar-Jacobs said. Questions remain to be answered about the best way to provide combination medications, Dr. Chesney said. These include the importance of exactly timed doses, how many doses are too many, and what meal recommendations to follow. It also is not clear which regimens work best for which patients, given the different histories and medical conditions among patient populations. The conference focused on creating an agenda to help HIV and AIDS patients adhere to combination drug therapies. Commonly discussed ways include reducing the number of pills taken and recognizing that it is not solely the patient's responsibility to stick to a medication schedule, said Dr. Gerald Friedland of Yale-New Haven Hospital. "We must construct systems of care around the issue of adherence," he noted. "Therapy must be chronic, long term, and perhaps lifelong," he said.