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Self reported treatment adherence and drug/alcohol use are associated with virologic outcomes in CCTG 570: a clinical strategy trial of HIV RNA antiretroviral (ARV) monitoring.




 

Int Conf AIDS. 1998;12:597 (abstract no. 32379). Unique Identifier :

OBJECTIVES: To evaluate the relationship between virologic and immunologic outcomes of ARV therapy and self-reported adherence. METHODS: In a randomized trial of intense HIV RNA (> 6 x/yr) vs mostly CD4 monitored (RNA 2x/yr) and unrestricted ARV therapy (CCTG 570), patients completed a self-report questionnaire at months 0, 2 and 6. Reported adherence during the past 4 weeks [categorized as adherent (> 95% = ADH) or not (< or = 95% = NA)] was compared to change in log10 HIV RNA (delta RNA) and CD4 (delta CD4) from baseline to months 2 and 6. Reported use of recreational drugs or alcohol, satisfaction with provider, and the provider's assessment of subject ADH were also evaluated. RESULTS: Neither assignment to RNA or CD4 monitored group nor satisfaction with the provider effected ADH (p > 0.05), but use of drugs or alcohol reduced ADH (47% vs 84%, p = .0006 at month 6). Patients who reported ADH and NA at baseline (n approximately 140) had similar delta RNA and delta at months 2 or 6. Patients who reported ADH at month 2 had greater delta RNA (-.9 vs -.4, p = 0.009) and delta CD4 (+37 vs; +19, p = 0.09) at month 2 than NA subjects, but these outcomes were not sustained at month 6. Subjects who reported ADH at month 6 had a better month 6 outcome (i.e., delta RNA -1.1 vs -.5, p = 0.02). The provider's estimation of patient ADH did not predict HIV RNA or CD4 response while use of alcohol or drugs was associated with poor response (delta RNA -0.1 vs -1.1, p < .01 at month 6). Sustained ADH (adherent at 2 of 3 questionnaires) and assignment to the RNA monitoring group were found to be independent predictors of viral suppression. Average HIV RNA reductions were .82 vs .57 in ADH vs NA patients (p = 0.04). CONCLUSION: Self reported ADH and drug or alcohol use were associated with virologic and immunologic outcomes of ARV therapy. Reported ADH predicted outcome independent of monitoring assignment (RNA vs CD4) in CCTG 570. Patients with consistent ADH had sustained HIV RNA suppression. Provider estimation of subject ADH did not predict treatment response. Self reported adherence can predict treatment outcome over the short term and may be useful to identify patients at risk for nonadherence.

MEETING ABSTRACTS CLINICAL TRIAL RANDOMIZED CONTROLLED TRIAL Alcohol Drinking/*EPIDEMIOLOGY Anti-HIV Agents/ADMINISTRATION & DOSAGE/*THERAPEUTIC USE Comorbidity Comparative Study CD4 Lymphocyte Count Drug Therapy, Combination Human HIV Infections/*DRUG THERAPY/EPIDEMIOLOGY/VIROLOGY HIV-1/*ISOLATION & PURIF *Patient Compliance/PSYCHOLOGY Patient Satisfaction Physicians/PSYCHOLOGY Risk Factors RNA, Viral/BLOOD/ISOLATION & PURIF Street Drugs Substance-Related Disorders/*EPIDEMIOLOGY Treatment Outcome *Viral Load Viremia/*DRUG THERAPY/EPIDEMIOLOGY/VIROLOGY



 




Information in this article was accurate in December 30, 1998. The state of the art may have changed since the publication date. This material is designed to support, not replace, the relationship that exists between you and your doctor. Always discuss treatment options with a doctor who specializes in treating HIV.