Decrease in HIV Concentration with Directly Observed Therapy in Treatment Experienced Adolescents: An Adherence Tool

2.50
Hdl Handle:
http://hdl.handle.net/10755/151439
Type:
Presentation
Title:
Decrease in HIV Concentration with Directly Observed Therapy in Treatment Experienced Adolescents: An Adherence Tool
Abstract:
Decrease in HIV Concentration with Directly Observed Therapy in Treatment Experienced Adolescents: An Adherence Tool
Conference Sponsor:Sigma Theta Tau International
Conference Year:2006
Author:Purdy, Julia Bilodeau, MSN, CPNP
P.I. Institution Name:National Institutes of Health
Title:Nurse Practitioner
Co-Authors:Alexandra F. Freeman, MD; Staci C. Martin, PhD; Celia Ryder, MSN, CPNP; Deborah K. Elliott-DeSorbo, MPhil; Steve Zeichner, MD, PhD; Rohan Hazra, MD
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.
Repository Posting Date:
26-Oct-2011
Date of Publication:
17-Oct-2011
Sponsors:
Sigma Theta Tau International

Full metadata record

DC FieldValue Language
dc.typePresentationen_GB
dc.titleDecrease in HIV Concentration with Directly Observed Therapy in Treatment Experienced Adolescents: An Adherence Toolen_GB
dc.identifier.urihttp://hdl.handle.net/10755/151439-
dc.description.abstract<table><tr><td colspan="2" class="item-title">Decrease in HIV Concentration with Directly Observed Therapy in Treatment Experienced Adolescents: An Adherence Tool</td></tr><tr class="item-sponsor"><td class="label">Conference Sponsor:</td><td class="value">Sigma Theta Tau International</td></tr><tr class="item-year"><td class="label">Conference Year:</td><td class="value">2006</td></tr><tr class="item-author"><td class="label">Author:</td><td class="value">Purdy, Julia Bilodeau, MSN, CPNP</td></tr><tr class="item-institute"><td class="label">P.I. Institution Name:</td><td class="value">National Institutes of Health</td></tr><tr class="item-author-title"><td class="label">Title:</td><td class="value">Nurse Practitioner</td></tr><tr class="item-email"><td class="label">Email:</td><td class="value">purdyj@mail.nih.gov</td></tr><tr class="item-co-authors"><td class="label">Co-Authors:</td><td class="value">Alexandra F. Freeman, MD; Staci C. Martin, PhD; Celia Ryder, MSN, CPNP; Deborah K. Elliott-DeSorbo, MPhil; Steve Zeichner, MD, PhD; Rohan Hazra, MD</td></tr><tr><td colspan="2" class="item-abstract">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.</td></tr></table>en_GB
dc.date.available2011-10-26T11:02:24Z-
dc.date.issued2011-10-17en_GB
dc.date.accessioned2011-10-26T11:02:24Z-
dc.description.sponsorshipSigma Theta Tau Internationalen_GB
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