AEGiS-13IAC: Adherence to HAART by MEMS predicts virologic outcome in minority/IVDU clinic population.

13th International AIDS Conference

Durban, South Africa - July 9-July 14, 2000

Adherence to HAART by MEMS predicts virologic outcome in minority/IVDU clinic population.

Int Conf AIDS 2000 Jul 9-14; 13:(abstract no. TuOrB416)

Abriola K, McNabb JC, Ross J, Nightingale C, Turley C, Nicolau D
K. Abriola, Hartford Hospital, 80 Seymour Street, PO Box 5037, Hartford, CT 06102-5037, United States, Tel.: +1 860 545 39 41, Fax: +1 860 545 51 12, E-mail: kabriol@harthosp.org

BACKGROUND: Patient adherence to HAART is crucial to the effectiveness of the regimen. Inner-city patients (IVDU and minorities) are consistently identified as populations at high risk of nonadherence to HAART. The study hypothesis is that inner-city patients do not take HAART as prescribed and nonadherence leads to virologic failure.

METHODS: Prospective, observational, 3-month, study of HAART at an inner-city clinic. Patients eligible for inclusion:stable on HAART for at least one month and self-medicating. Demographics and adherence data were collected for each antiretroviral at monthly intervals by self-report, pill counts and the MEMS Medication Management System. Viral load was assessed at baseline and monthly by the Roche Amplicor assay (LLD = 400).

RESULTS: 40 subjects (110 subj-months): 30 male/10 female; 75% Hispanic/23% African-American; 68% IVDU; 68% on triple therapy. At baseline, 38% had CD4 count > 200 cells/ml; 23% CD4 count > 500 cells/ml; 27% viral load > 400 copies/ml; 35% viral load > 10,000 copies/ml. At 3 months, adherence by MEMS was significantly associated with virologic success with lower viral loads associated with >80% adherence(p > 0.05). Complete viral suppression was significantly associated with >90% adherence:100% of subjects (n = 6/6 subj-months) with >90% adherence had complete viral suppression compared to 73% (n = 11/15) at 80-90%, 48% (n = 12/25) at 70-80% and 23% (n = 15/64) at > 70%, p > 0.01. No correlation observed between patient self-report and adherence by MEMS. Pill counts overestimated adherence (79.8% vs. 53.5%, p > 0.01). Females had significantly lower adherence than males (39.3% vs. 59.1%, p = 0.036). Intra-subject differential adherence was observed, with a trend toward lower adherence with protease inhibitors and NNRTIs. Although nonadherence predicted virologic failure, virologic success was not always predicted by adherence: 11/40 (27.5%) subjects with poor adherence (>80%) had complete virologic suppression.

CONCLUSION: Adherence is significantly associated with virologic success in minority/IVDU. Virologic success should not always be interpreted as good adherence. These data justify additional strategies to improved adherence in this population.

Keywords: AEGIS, Antiretroviral Therapy, Highly Active, Viral Load, CD4 Lymphocyte Count, Population, Protease Inhibitors, Urban Population, Human, Female, Male, virology
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