UCSF study shows short-term delay in AIDS progression is possible even when patients fail to take all of their antiviral medications

June 11, 2001

UCSF researchers have found that HIV-infected homeless and marginally housed people who have trouble sticking to their antiviral regimens may temporarily delay the onset of full blown AIDS if they manage to take at least half of their anti-HIV medications.

The UCSF study, published in the June 1, 2001 issue of AIDS, found that only 8 percent of the patients who took between 51 percent and 90 percent of their antiviral medications over the 13 months of follow-up progressed to AIDS.

Progression to AIDS is defined as a decline in CD4 cell count to below 200 cells or the development of an opportunistic infection. None of the study participants who took 90 percent or more of their medications progressed to AIDS during the follow-up period. Of those who took 50 percent or less of their medications, 41 percent progressed to AIDS.

"This study shows that adherence to medication regimens is not only closely related to viral suppression, but also disease progression. Yet we were surprised that very few of the patients with moderate levels of adherence, in the range of 50-90 percent, developed AIDS.

These levels of adherence are too low to achieve durable viral suppression in most people," said the study's lead author, David R. Bangsberg, MD, MPH, UCSF assistant professor of medicine and director of the Epidemiology and Prevention Interventions (EPI) Center at San Francisco General Hospital Medical Center (SFGHMC). Bangsberg cautioned however that the long-term benefit, specifically over decades, may be quite different and may require higher levels of adherence.

"This study suggests that the more pills you take, the better you do," said study co-author Andrew Moss PhD, UCSF professor of epidemiology and medicine. "The relationship between adherence and clinical benefit is a continuum, not an all-or-none phenomenon. For every 10 percent increase in adherence we found a 28 percent reduction in the risk of proceeding to AIDS."

The study assessed whether 76 HIV-infected homeless and marginally housed individuals without AIDS who were taking anti-HIV therapy actually took their medications. Researchers counted pills every 3 to 6 weeks at the participants' usual places of residence to measure adherence to antiviral therapy. Thirty two percent had low adherence; they took less than 50 percent of their antiviral medications as prescribed. Almost half, 49 percent, had moderate adherence (between 51 percent and 90 percent), and 20 percent took more than 90 percent of their medications as prescribed.

The levels of HIV virus in each participant's blood was measured monthly and their CD4 cells (the disease fighting blood cells targeted and destroyed by HIV) were measured quarterly. The San Francisco Department of Public Health's AIDS Surveillance Registry was used to identify opportunistic infections not detected by the study.

At the beginning of the study, 47 (61 percent) had never received antiviral therapy. Subjects who had initiated antiviral therapy before the study began had been on therapy a median of 14 months.

The study population had a high risk for non-adherence. Ninety-three percent of the participants were homeless, 86 percent were male, 59 percent were non-white, 32 percent had had psychiatric hospitalization, and 29 percent had a high prevalence of recent injection drug use.
Study co-authors are Sharon Perry, statistician, and Richard A. Clark, senior public administrative analyst, both with UCSF's Department of Epidemiology and Biostatistics at SFGHMC; Edwin D. Charlebois, PhD, MPH, UCSF assistant professor of medicine at the EPI Center at SFGHMC; Marjorie Robertson, PhD, senior scientist at the Alcohol Research Group at the Public Health Institute, Berkeley; and Andrew R. Zolopa, MD, assistant professor of medicine at Stanford University's School of Medicine.

The study was funded by the National Institute of Mental Health, the University-Wide AIDS Research Program of the State of California, the UCSF/Gladstone Institute for Virology and Immunology Center for AIDS Research and the Doris Duke Charitable Foundation.

University of California - San Francisco

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