Adherence to protease inhibitors, HIV-1 viral load, and development of drug resistance in an indigent population

被引:795
作者
Bangsberg, DR
Hecht, FM
Charlebois, ED
Zolopa, AR
Holodniy, M
Sheiner, L
Bamberger, JD
Chesney, MA
Moss, A
机构
[1] Univ Calif San Francisco, San Francisco Gen Hosp, Div Infect Dis, Epidemiol & Prevent Intervent Ctr, San Francisco, CA 94110 USA
[2] Univ Calif San Francisco, San Francisco Gen Hosp, Posit Hlth Program, San Francisco, CA 94110 USA
[3] Univ Calif San Francisco, Dept Lab Med & Biopharmaceut Sci, San Francisco, CA 94110 USA
[4] Univ Calif San Francisco, Ctr AIDS Prevent Studies, San Francisco, CA 94110 USA
[5] Univ Calif San Francisco, Dept Epidemiol & Biostat, San Francisco, CA 94110 USA
[6] Stanford Univ, Sch Med, Div Infect Dis & Geog Med, Palo Alto, CA 94304 USA
[7] VA Palo Hlth Care Syst, Ctr AIDS Res, Palo Alto, CA USA
[8] San Francisco Dept Publ Hlth, San Francisco, CA USA
关键词
access to therapy; adherence; HIV; highly active antiretroviral therapy; homeless; injection drug use; protease inhibitor; resistance; viral load;
D O I
10.1097/00002030-200003100-00008
中图分类号
R392 [医学免疫学]; Q939.91 [免疫学];
学科分类号
100102 ;
摘要
Objective: To examine the relationship between adherence, viral suppression and antiretroviral resistance in HIV-infected homeless and marginally housed people on protease inhibitor (PI) therapy. Design and setting: A cross-sectional analysis of subjects in an observational prospective cohort systematically sampled from free meal lines, homeless shelters and low-income, single-room occupancy (SRO) hotels. Participants: Thirty-four HIV-infected people with a median of 12 months of PI therapy. Main outcomes: Adherence measured by periodic unannounced pill counts, electronic medication monitoring, and self-report; HIV RNA viral load; and HIV-1 genotypic changes associated with drug resistance. Results: Median adherence was 89, 73, and 67% by self-report, pill count, and electronic medication monitor, respectively. Thirty-eight per cent of the population had over 90% adherence by pill count. Depending on the measure, adherence explained 36-65% of the variation in concurrent HIV RNA levels. The three adherence measures were closely related. Of 20 genotyped patients who received a new reverse transcriptase inhibitor (RTI) when starting a Pi, three had primary protease gene substitutions. Of 12 genotyped patients who received a PI without a new RTI, six had primary protease gene substitutions (P < 0.03). Conclusion: A substantial proportion of homeless and marginally housed individuals had good adherence to PI therapy. A strong relationship was found between independent methods of measuring adherence and concurrent viral suppression. PI resistance was more closely related to the failure to change RTI when starting a PI than to the level of adherence. (C) 2000 Lippincott Williams & Wilkins.
引用
收藏
页码:357 / 366
页数:10
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