TY - JOUR
T1 - Adherence to protease inhibitors, HIV-1 viral load, and development of drug resistance in an indigent population
AU - Bangsberg, David R.
AU - Hecht, Frederick M.
AU - Charlebois, Edwin D.
AU - Zolopa, Andrew R.
AU - Holodniy, Mark
AU - Sheiner, Lewis
AU - Bamberger, Joshua D.
AU - Chesney, Margaret A.
AU - Moss, Andrew
PY - 2000
Y1 - 2000
N2 - Objective: To examine the relationship between adherence, viral suppression and antiretroviral resistance in HIV-infected homeless and marginally housed people on protease inhibitor (PI) therapy. Design and setting: A cross-sectional analysis of subjects in an observational prospective cohort systematically sampled from free meal lines, homeless shelters and low-income, single-room occupancy (SRO) hotels. Participants: Thirty-four HIV-infected people with a median of 12 months of PI therapy. Main outcomes: Adherence measured by periodic unannounced pill counts, electronic medication monitoring, and self-report; HIV RNA viral load; and HIV-1 genotypic changes associated with drug resistance. Results: Median adherence was 89, 73, and 67% by self-report, pill count, and electronic medication monitor, respectively. Thirty-eight per cent of the population had over 90% adherence by pill count. Depending on the measure, adherence explained 36-65% of the variation in concurrent HIV RNA levels. The three adherence measures were closely related. Of 20 genotyped patients who received a new reverse transcriptase inhibitor (RTI) when starting a PI, three had primary protease gene substitutions. Of 12 genotyped patients who received a PI without a new RTI, six had primary protease gene substitutions (P < 0.03). Conclusion: A substantial proportion of homeless and marginally housed individuals had good adherence to PI therapy. A strong relationship was found between independent methods of measuring adherence and concurrent viral suppression. PI resistance was more closely related to the failure to change RTI when starting a PI than to the level of adherence. (C) 2000 Lippincott Williams and Wilkins.
AB - Objective: To examine the relationship between adherence, viral suppression and antiretroviral resistance in HIV-infected homeless and marginally housed people on protease inhibitor (PI) therapy. Design and setting: A cross-sectional analysis of subjects in an observational prospective cohort systematically sampled from free meal lines, homeless shelters and low-income, single-room occupancy (SRO) hotels. Participants: Thirty-four HIV-infected people with a median of 12 months of PI therapy. Main outcomes: Adherence measured by periodic unannounced pill counts, electronic medication monitoring, and self-report; HIV RNA viral load; and HIV-1 genotypic changes associated with drug resistance. Results: Median adherence was 89, 73, and 67% by self-report, pill count, and electronic medication monitor, respectively. Thirty-eight per cent of the population had over 90% adherence by pill count. Depending on the measure, adherence explained 36-65% of the variation in concurrent HIV RNA levels. The three adherence measures were closely related. Of 20 genotyped patients who received a new reverse transcriptase inhibitor (RTI) when starting a PI, three had primary protease gene substitutions. Of 12 genotyped patients who received a PI without a new RTI, six had primary protease gene substitutions (P < 0.03). Conclusion: A substantial proportion of homeless and marginally housed individuals had good adherence to PI therapy. A strong relationship was found between independent methods of measuring adherence and concurrent viral suppression. PI resistance was more closely related to the failure to change RTI when starting a PI than to the level of adherence. (C) 2000 Lippincott Williams and Wilkins.
KW - Access to therapy
KW - Adherence
KW - HIV
KW - Highly active antiretroviral therapy
KW - Homeless
KW - Injection drug use
KW - Protease inhibitor
KW - Resistance
KW - Viral load
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U2 - 10.1097/00002030-200003100-00008
DO - 10.1097/00002030-200003100-00008
M3 - Article
C2 - 10770537
AN - SCOPUS:0034027217
SN - 0269-9370
VL - 14
SP - 357
EP - 366
JO - AIDS
JF - AIDS
IS - 4
ER -