Bridging the Gap: Conference Record [Abstract book, International Conference on AIDS (12th: 1998: Geneva, Switzerland)]

12th World AIDS Conference

Abstracts 32331-32334 587

Results: 126 paired samples were analysed. The saliva:plasma ratio could not
be calculated for 22 paired samples because in these samples plasma (4.8%)
and/or saliva (15.1%) concentrations were below the lower limit of quantitation (50
ng/mL). It was especially at 7 and 8 hrs after ingestion that no ratio could be calculated. Finally, for 103 paired samples the saliva:plasma ratios were estimated. The
salivary IDV concentrations show a high correlation (r = 0.85) with corresponding
plasma levels. The median saliva:plasma ratio is 52.2% (9.4-392.1). The median
Area Under the Curve saliva:plasma ratios are in agreement with the individual
saliva:plasma ratios (50.5% (23.6-107.9). The ratios are independent of concentration; however, there does seem to be a relation with time after ingestion, which
has to be further investigated.
Conclusions: This study shows that IDV is measurable in saliva and that
salivary concentrations are highly correlated with plasma IDV levels. Checking
compliance with salivary IDV levels is possible, insofar that ingestion of IDV can
be reliably assessed between 1 and 6 hrs after the last dose. Before adopting
saliva as a specimen to predict plasma IDV levels, the exact relationship between
saliva and plasma levels has to be established.
32331 Attitudes and age are related to adherence to
combination therapy in HIV-1 positive gay men
Jeffrey J. Weiss1, M.H. Antoni2, C.L. Mulder1, B. Garssen1. 1Helen Dowling
Institute Mathenesserlaan 183 3014 HA Rotterdam, USA; 2University of Miami,
Coral Gables FL, Netherlands
Objectives: To identify the most important determinants of adherence to highlyactive antiretroviral therapy (HAART).
Design: Cross-sectional.
Methods: The sample is composed of 40 gay men, aged 25 to 58 years (M =
42.4) who have known that they are HIV-positive for 17 to 152 months (M = 64.9).
They have been using HAART from 1 to 17.5 months (M = 7.9) and 15/40 were
antiretroviral naive pre-HAART. 5/40 have an AIDS diagnosis. Adherence was
coded on a 6 point scale based on self-report of number of missed doses in the
last week and carelessness in following the prescribed pill-taking regimen. As a
first step in the analyses, the relationship was determined between adherence and
the following 15 theoretical determinants: MOS-HIV scales (Cognitive Function,
Health Distress, Mental Health, Vitality); Protease Inhibitor Optimism/Skepticism
(O/S) attitude scale; self-involvement in medication decisions; time known HIVpositive; current age; and related specifically to HAART: number of months
using; degree of side-effects experienced; number of medications in the therapy;
knowledge of viral load response; antiretroviral naive or experienced prior; first
or second combination; and level of knowledge. Secondly, the variables found
to be correlated with adherence (p <.10, 2-tailed) were entered into a multiple
regression analysis with adherence as the dependent variable.
Results: The variables found to be correlated with adherence are: attitude
towards HAART (O/S scale) (r = -.462; p = 003), current age (r =.315; p =.048),
months using HAART (r = -.279; p =.081) and Health Distress (r =.276; p =.084). The regression equation is significant F (4.35) = 5.58, p =.001; explained
variance = 32%. The two predictors which account for unique variance are the
O/S attitude scale (p = -.423, p =.003) and current age (/ =.308, p =.027).
Months using HAART approached significance (/ = -.237, p =.085). A more
skeptical attitude towards HAART, an older age, and less time using HAART are
related to better HAART adherence.
Conclusion: The unexpected finding that a more skeptical attitude towards
HAART is related to better adherence warrants further study. It may be that those
who are more optimistic feel less personal responsibility for HAART's effectiveness. A more skeptical attitude, on the other hand, may go along with seeing
a greater role for oneself (optimizing adherence) in determining therapeutic response. HIV-positive persons have been disappointed by new therapies before.
Skepticism towards HAART may offer protection against feared disappointment
and thereby facilitate making a behavioral investment (strict adherence). The
results also suggest that special attention should be paid to adherence in younger
persons and to the problems of maintaining adherence after many months on
HAART.

well as a calendar of events. The newsletter is free of charge - the project is
financed by the Swiss AIDS Federation.
Results: According to unofficial estimates, about 15,000 people out of 15,000
to 25,000 people living with HIV/AIDS in Switzerland undergo a combination
therapy. The newsletter currently attains a circulation of 4000 copies, with a clear
upward trend.
Conclusion: There is a pronounced need for independent and detailed information on HIV/AIDS therapies. Not only many people living with HIV/AIDS
but also medical staff and collaborators of AIDS relief centers or other advice
centers appreciate the newsletter and use it as important source of information. It
helps people living with HIV/AIDS to develop and maintain good compliance. For
compliance is not a quality that a patient "has" or "lacks", but rather the result of
a process in which he or she is directly involved.
32333 1 Educational and support needs of people living with HIV
(PLWH) to improve adherence to highly active
antiretroviral therapy (HAART)
Laureen Kunches1, J.M. Mazzullo1, E. Miller-Mack2, M. Russell1, Z. Ortega2'.
1JSI, 44 Farnsworth St Boston, MA 02210; 2Brightwood Health Center,
Springfield, MA, USA
Objectives: To assess the degree of adherence, treatment awareness and current needs of PLWH who are taking HAART, as part of developing an effective
adherence-enhancing intervention.
Design: Qualitative research with a diverse sample of PLWH taking a variety of HAART regimens, who received their medical care from several highly
HIV-experienced clinical sites in Massachusetts.
Methods: Focus groups (in 3 geographic regions) and individual interviews at
5 clinical sites, involving 50 PLWH; 56% were women, 46% were Black, 34%
were Hispanic, and 34% disclosed ongoing substance abuse problems. Data
were collected from 4/97 thru 6/97, before most formalized adherence activities
were in place.
Results: Overall, only 50% of participants thought they had properly taken (by
schedule and food requirements) 90% or more of their medication doses in the
previous month. A feeling of intense pressure from peers, family and medical
providers to take HAART was common, and resulted in significant fear of failure
to meet expectations. Related to this was the expressed embarrassment about
asking "dumb" questions and decisions to postpone seeking help with adherence
problems until the next appointment rather than call the provider to get immediate
help. Mistrust of the pharmaceutical industry's motives and degree of influence
over medical providers often fueled skepticism about the treatments. Significant
confidentiality concerns limited PLWH in certain communities from seeking help
with their medication issues. Study participants with good adherence emphasized
the need for high levels of personal motivation and ongoing social support to overcome negative drug effects (unpleasant taste, side effects, difficulty swallowing
pills).
Conclusion: Adherence programs should address knowledge gaps about
medication requirements (dosing times, storage and drug interactions) and promote skill development (organizing schedules, managing side effects, planning
ahead and cuing to remember doses). Clinic activities should be complemented
by independent support systems (like telephone hotlines), which allow easy access to specialized resources and create a safety net to overcome the barriers of
embarrassment, mistrust and fear of disclosure that jeopardize treatment success.
32334 Highly active antiretroviral therapy (HAART) in the "real
world": Experiences in an inner-city community health
center (CHC)
Lisa Hirschhorn1, J. Quinones2, S. Goldin', L. Metras1. 1Dimock Community
Health Center 55 Dimock St, Roxbury, MA; 2Yale Univ Schol of Medicine New
Haven CT, USA
Objective: To describe the use of HAART in a CHC and explore barriers to
achieving a durable response
Methods: Retrospective chart review of all patients (pts) receiving primary care
at Dimock (DCHC) who were prescribed a HAART regimen containing -- protease
inhibitor (PI) between 1/1/96 and 7/31/97. Durable response was an undetectable
viral load at _24 weeks. Only first PI exposure was analyzed.
Results: 72/117 (61.5%) pts were prescribed HAART during the study period:
27 (37.5%) women, 51 (70.8%) minorities, 48 (66.7%) with AIDS. HIV risks included 37.5% IDU, 16.7% male homosexual, 34.7% heterosexual. Pis included
indinavir (43), ritonavir (7), saquinavir (3), nelfinavir (10) and ritonavir+saquinavir
(9). 42/72 (58.3%) pts did not achieve a durable response. Pt's who had HAARTfailure were more likely to have AIDS (81% vs 46.7%, p -.01), lower mean CD4
pre-HAART (207 vs 293, p =.02), less likely to have;-1 new drug added with the
PI (70% vs 88%, p =.09) and more likely to have toxicity or significant side effects
(SE) (62.9% vs 30%, p =.008) and suspicion of nonadherence (72.5% vs 28%).
There was no difference in gender, ethnicity or HIV risk. Of pts with a suspicion
of poor adherence, 61% had either toxicity or significant SE vs 41% of those who

had good adherence (p =.06). 15/42 (35.6%) of HAART failures were unable
to tolerate therapy for >24 weeks (13 on 12 weeks) due to treatment limiting
SE or toxicities (nausea, diarrhea, hepatitis, renal failure, excessive weight gain).
Adherence was also interrupted by relapsed substance abuse, incarceration and
depression.
Barriers to a durable response to HAART for pts in a CHC included advanced
disease, limited new ART choices, treatment limiting SE and toxicities, and

32332]

"Bridging the gap" between the world of medicine and
people living with HIV/AIDS as prerequisite for good
compliance

Max Rohr. AIDS-Hilfe Schweiz, Postfach CH-8031, Zurich, Switzerland
Issues: Compliance (adherence) is highly important for the success or failure of
combination therapies against HIV/AIDS. Experience shows that detailed counselling and intense dealing with the issue before starting a therapy are crucial
factors for good compliance. For patients well informed, it is easier to commit
themself to a therapy probably lasting for years, to adhere to complex instructions
for medicine taking and to deal with potential side effects. Specialized centers for
medical treatment often do not have enough time and staff for comprehensive
information and counselling, whereas the specialized knowledge about HIV of
doctors who are in close contact with their patients is often limited or out-of-date.
Project: The Swiss AIDS Treatment Group (SATG) aims to bridge the information gap between the world of medicine and patients. Since September 1996,
the SATG is therefore publishing an eight-pages newsletter. It appears every two
months in German and French and deals with important research results as well
as different aspects of HIV/AIDS therapies, the highly specialized content being
written in a comprehensible language. Furthermore, this newsletter contains a
forum in which experts answer the questions of people living with HIV/AIDS as