Only Eight Percent Of San Francisco HIV-Positive Urban Poor Receive Protease Inhibitors

July 01, 1998

Geneva, Switzerland -- In the first large-scale study of HIV treatment among the urban poor, University of California San Francisco AIDS researchers have found that very few of the HIV-infected poor receive drugs to combat the virus. Of those who do take anti-retroviral drugs, the researchers found a range of how well the patients adhered to their drug-taking regimens, ranging from 24 to 100 percent of prescribed levels. If subjects missed more than 10 percent of their drugs, the HIV treatment became ineffective.

The research project, called the REACH study for "Research in Access to Care in the Homeless," was started in response to concerns that the urban poor may develop resistant strains of HIV as a result of not adhering to their therapy. The UCSF team looked at how many of these people who were HIV-infected received therapy, how well they adhered to their regimens, and how the virus responded. David Bangsberg, MD, MPH, assistant professor of medicine at the UCSF AIDS Program at San Francisco General Hospital, was medical director of the study. He presented the research findings here today (July 1) at the 12th World AIDS Conference.

"This is the first study of anti-retroviral use in a population that makes up a growing portion of the HIV epidemic," said Andrew Moss, PhD, professor of epidemiology and medicine at UCSF and principal investigator. "Poor people are increasingly the main high-risk group for HIV."

Bangsberg said, "Most people think studies can't be done with the homeless because they are hard to keep track of. We found that to be untrue. Of 153 people in the study, we know where 151 of them are now, after more than a year." The UCSF team identified participants for the research project in free food lines, homeless shelters and low-income hotels and tested them for HIV infection. For those HIV-positive people on protease inhibitors, the researchers looked at three measures of adherence: self-report, random pill counts, and a digital cap that registered whenever the pill bottle was opened. Looking at 151 HIV-infected urban poor in San Francisco, the researchers found: "While the level of adherence in these patients would be very good for most other diseases," said Moss, "patients with HIV infection in our study had to take more than 90 percent of their medications to have a good chance of decreasing their viral loads to an undetectable level."

Bangsberg emphasized the socioeconomic issues surrounding the urban poor that influence how well people are able to adhere to therapy. "Even in the era of protease inhibitor therapy, the priorities for this population remain housing, prevention of tuberculosis and other opportunistic infections, and treating drug dependency and mental illness," he said.

The UCSF group outlined this issue in "Protease Inhibitors in the Homeless," a commentary in the July 2, 1997 Journal of the American Medical Association. Other co-investigators in the REACH study from UCSF are Frederick Hecht, MD, assistant clinical professor at San Francisco General Hospital; Margaret Chesney, PhD, professor of medicine; Jacqueline Tulsky, MD, assistant clinical professor at San Francisco General Hospital; Edwin Charlebois, MPH, PhD-candidate in epidemiology and biostatistics; and Marjorie Robertson, PhD, associate researcher in epidemiology and biostatistics.

Co-investigators from Stanford University School of Medicine are Andrew Zolopa, MD, assistant professor; Mark Holodniy, MD, assistant professor; and Thomas Merigan, MD, professor; and from the San Francisco Department of Public Health, Joshua Bamberger, MD.
-end-


University of California - San Francisco

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