Paper
Friday, 21 July 2006
This presentation is part of : HIV/AIDS and Infectious Diseases
Decrease in HIV Concentration with Directly Observed Therapy in Treatment Experienced Adolescents: An Adherence Tool
Julia Bilodeau Purdy, MSN, CPNP, Alexandra F. Freeman, MD, Staci C. Martin, PhD, Celia Ryder, MSN, CPNP, Deborah K. Elliott-DeSorbo, MPhil, Steve Zeichner, MD, PhD, and Rohan Hazra, MD. National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
Learning Objective #1: The learner will be able to discuss use of directly observed therapy as an adherence tool.
Learning Objective #2: The learner will be able to describe changes in HIV viral load when directly observed therapy is utilized in treatment experienced patients.
Background: Virologic response to highly active antiretroviral therapy (HAART) in treatment of human immunodeficiency virus (HIV) infection depends on excellent medication adherence and viral sensitivity to antiretrovirals (ARVs). Adolescents with vertically acquired HIV often have poor medication adherence, and may require complicated regimens due to significant treatment experience. We examined whether patients with ARV- resistant HIV and poor virologic response on HAART could respond virologically with directly observed therapy (DOT). Methods: A retrospective chart review was performed for patients who had DOT in clinic with serial HIV concentration measurements after having plasma viral concentration rebound or nonresponse on a stable HAART regimen. Adherence was monitored by interview, pill count, and/or Medication Event Monitoring System (MEMS). Results: Five adolescents with vertically acquired HIV with virologic rebound or nonresponse on HAART were identified who received DOT for at least 4 days. All patients had significant ARV resistance (median of 5 major mutations in the reverse transcriptase gene and nine in the protease gene), and significant treatment experience (median of 4 previous HAART regimens). Adherence was assessed through interview for 5 patients, MEMS and pill counts for two patients. Despite reassuring adherence interviews, pill counts, and MEMS‚ data prior to DOT, four of the five patients had a virologic response during DOT (mean decline of HIV concentration 1.15 log). At 4-8 weeks after DOT, HIV concentration increased for all patients (mean increase of 0.86 log). Conclusions: A virologic response to HAART can be seen despite ARV resistance using DOT, and many treatment experienced patients who seem unresponsive to HAART may be non-adherent despite reassuring patient reports, pill counts and MEMS‚. A period of clinic-monitored DOT allows diagnosis of non-adherence, and avoids unnecessary medication changes in a highly treatment experienced group.

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