Journal
AIDS
Volume 14, Issue 4, Pages 357-366Publisher
LIPPINCOTT WILLIAMS & WILKINS
DOI: 10.1097/00002030-200003100-00008
Keywords
access to therapy; adherence; HIV; highly active antiretroviral therapy; homeless; injection drug use; protease inhibitor; resistance; viral load
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Funding
- NIMH NIH HHS [R01 MH054907, P30 MH59 037, T32 MH-19105-10] Funding Source: Medline
- PHS HHS [54907] Funding Source: Medline
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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.
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