Abstract Book Vol. 2 [International Conference on AIDS (14th: 2002: Barcelona, Spain)]

XIV International AIDS Conference

Abstracts WePeB5821-WePeB5824 37

Cumulated rates of HAART withdrawal and therapeutic failures at week
48 were: d4T+3TC+SQV 51.72% and 44.83%; d4T+3TC+NFV 46.15% and
26.92%; d4T+3TC+IDV 37.50% and 17.50%; d4T+ddl+NFV 38.64% and 9.09%;
AZT+3TC+IDV 32.14% and 12.50%; AZT+3TC+NFV 25% and 15%.
Conclusions: 32.47% of patients were lost to follow-up after prescribing HAART,
raising poor or non-adherence as the major problem. For the remaining, failure
was the mean factor associated with HAART withdrawal (50.57%). Patients receiving d4T+3TC+SQV or d4T+3TC+NFV had the highest rates of therapeutic
failure (44.83% and 34.62%). The former also showed higher median plasma
level.
Presenting author: Antonio Montero, Dorrego 156 50, 2000-Rosario, Argentina,
Tel.: [phone], E-mail: amontero @ sede.unr.edu.ar
WePeB5821 Evaluating electronic monitoring device use to
measure antiretroviral adherence
C.A. Bova1, K. Fennie2, G. Knafl2, K. Dieckhaus3, E. Watrous2, A.B. Williams2.
1 University of Massachusetts, PO Box 215, Princeton, MA, 01541, United
States; 2 Yale School of Nursing, New Haven, United States; 3 University of
Connecticut Health Center, Farmington, United States
Background: Electronic monitoring devices (EMD) are often presented as the
reference standard for measurement of adherence to antiretrovirals. However,
lack of discussion of logistical problems associated with this technology has led to
an overly positive view of the ease of use and quality of data associated with this
technology. Therefore, the purpose of this study is to describe EMD use among
HIV-infected adults enrolled in a
15-month randomized clinical trial.
Methods: This is a descriptive, exploratory study of EMD use among 172 HIV infected adults treated with at least three antiretroviral agents. All subjects received
detailed instructions on the use of the EMD including a 4-week lead in period, full
disclosure about the purpose of the EMD and a 72-hour call back. Data were collected using a structured questionnaire at month 12 and from comments elicited
from subjects throughout the study during scheduled face-to-face interviews.
Results: The sample includes 50% women, 75% substance users, and 37% with
AIDS. There were no differences in responses to EMD survey questions by gender, age, race, substance abuse, baseline viral load, CD4 cell count or adherence
rates. 36% of the sample admitted that they did not use the EMD consistently.
41% of the subjects reported taking out more than one dose at a time and 26%
reported opening the EMD but not taking the medication. 29% reported that the
use of a pillbox was a major barrier to EMD use. Social problems accounted for
11% of all reported problems with EMD use (e.g., transient housing, incarceration and in-patient drug treatment) and 8% experienced actual technical problems
with the EMD.
Conclusions: Data from this study suggest that EMDs may underestimate antiretroviral adherence among HIV infected adults. Recommendations for improving EMD data quality will be presented.
Presenting author: Carol Bova, PO Box 215, Princeton, MA, 1541, United
States, Tel.: [phone], Fax: [phone], E-mail: carol.bova
@ umassmed.edu
WePeB5822 Adherence to antiretroviral treatment in
HIV-infected children: the critical role of
psychosocial factors
C.A. Mellins1, E. Brackis-Cott', C. Dolezall, E.J. Abrams2. 1 HIV Center for
Clinical and Behavioral Studies, NYSPI and Columbia University, New York, NY
United States; 2Harlem Hospital and Columbia University, NYC, United States
Background: The initial optimism concerning advances in antiretroviral therapy
has been tempered by recognition of significant challenges to adherence posed
by the nature of the medications and the context of patients' lives. This study
examines biopsychosocial factors influencing adherence in HIV+ children.
Methods: 75 perinatally-infected children (3-13 years old) taking antiretroviral
medication and their primary caregivers were recruited from 2 inner-city NYC
primary care pediatric HIV programs. Self-report data were collected from the 75
primary caregivers and 48 children who were > 6 years old, in individual interviews using validated instruments. Medical chart data were collected on CD4+
cell counts and HIV RNA viral load. Participants were primarily African American
and Latino and of low socioeconomic status.
Results: A high percentage of caregivers (40%) and children (50%) reported
problems with adherence in the past month. Families in which the caregiver or
child reported adherence problems were compared to families who reported no
problems. Most demographics, child health status, and HIV treatment knowledge
were not significantly associated with adherence. Family and psychosocial factors
were the most strongly associated with adherence problems (ps < 0.05), including 1) worse parent-child communication; 2) higher caregiver and child stress; 3)
less HIV disclosure to others; 4) lower caregiver quality of life; 5) less caregiver

self-efficacy re: adherence; 6) increased caregiver cognitive impairment; and 7)
older child age.
Conclusions: To date, adherence interventions have focused on improving
knowledge and medication taking skills. Our data suggest that focusing on the
psychosocial needs of the families of HIV+ children, reducing stress, and improving family communication and quality of life may also improve adherence to
complex antiretroviral regimens in this population.

Presenting author: Claude Mellins, HIV Center for Clinical and Behavioral Studies, Box 15, 1051 Riverside Drive, New York, NY 10032, United States, Tel.: +1
212 342 0447, Fax: [phone], E-mail: [email protected]
WePeB5823I Differential predictors of HAART adherence as a
function of gender
R.S. Durvasula1, K.I. Mason2, D. Thrasher2, M. Ropacki2, T. Farchione2,
M. Stefaniak2, R. Schug2, S.A. Castellon3, M.N. Lam3, D.J. Hardy2,
C.H. Hinkin3. 1California State University Los Angeles, Los Angeles, United
States; 2UCLA Department of Psychiatry, Los Angeles, United States; 3 UCLA
Dept. of Psychiatry & VA Greater Los Angeles Healthcare System, Los Angeles,
United States
Background: Differences in psychosocial predictors of HAART adherence as a
function of gender were examined.
Method: The sample was comprised of 162 HIV+ individuals, 130 men and 32
women. Medication adherence was assessed using medication events monitoring system (MEMS) caps.
Results: Mean age of the male sample was 44.1 years, for females it was 43.4
years. Mean adherence accuracy for the men was 79.6% while for women it was
71.6%. No gender difference in adherence was noted. Because adherence rates
are negatively skewed, adherence data was logged prior to statistical analyses.
For women, only perceived barriers were found to be associated with adherence
(r = -0.43, p = 0.03) with greater barriers associated with poorer adherence. For
men, perceived utility (r = 0.36, p < 0.001), intentions to adhere (r = 0.39, p <
0.001), MOS scores (r = 0.54, p < 0.001), and age (r = 0.24, p = 0.009) were all
found to be associated with adherence, with higher perceived utility, greater intentions to adhere, higher levels of efficacy (MOS), and older age associated with
greater adherence. The multiple significant predictors for men were entered into
a simultaneous regression model, and results reveal that controlling for the other
predictors, only total MOS score remained a significant predictor of adherence (f
= 0.44, t = 5.2, p< 0.001).
Conclusions: These results suggest that predictors of medication adherence differ as a function of gender. While cognitive variables such as self-efficacy and
intent to follow medical recommendations are robust predictors of adherence in
men, practical rather than cognitive barriers impede women's adherence. Given
that HIV+ women are more often responsible for caregiving duties, and may have
fewer economic resources, alleviation of practical barriers may need to be targeted before cognitive variables such as efficacy are addressed. Findings suggest that adherence interventions must be developed contextually
Presenting author: Charles Hinkin, UCLA NPI C8-747, 760 Westwood Plaza,
Los Angeles, CA, 90024, United States, Tel.: [phone], Fax: [phone], E-mail: [email protected]
WePeB5824 Lipodystrophy is related to adherence to
antiretroviral therapy (ART)
G. Guaraldil, G. Orlando', R. Murri2, E. Orlandi3, R. Covezzil,
G.K. Sterrantino4, S. Sbaragli4, M. Borderi5, S. Talo5, C. Grosso6, C. Erba7,
A.M. Cattellan8, A. Antinori9, G. Nardinil, B. Beghetto', R. Esposito1, A. Wu10.
Universita di Modena, Clinica Malattie Infettive, via del Pozzo, 71, 41100,
Modena, Italy; 2Universita Cattolica, Roma, Italy; 3Universita di Modena,
Modena, Italy; 40spedale Careggi, Firenze, Italy; 50spedale S. Orsola, Bologna,
Italy; 60spedale di Cesena, Cesena, Italy; 7Universita di Parma, Parma, Italy;
8Ospedale di Padova, Padova, Italy; 9/RCCS Spallanzani, Roma, Italy; 10John
Hopkins University, Baltimore, United States
Background: It is not known whether lipodystrophy is related to adherence to
ART GRAAL is a prospective observational study to examine lipodystrophy and
its relationship to medication adherence.
Methods: Cross sectional survey in an Italian clinic-based cohort of HIV infected
patients (N=175). Questionnaires assessed the patient's evaluation of lipodystrophy, adherence behaviour, and reasons for taking and missing therapy Logistic
regression was used to test associations of sex, CDC group, detectable HIV-RNA
and measures of adherence and quality of life with the presence of self-assessed
lipodystrophy
Results: Using the MACS classification, 83 (47.4%) patients had lipodystrophy, and 92 (52.5%) did not. In bivariate analysis, self-reported non-adherence
(missed therapy "yesterday" versus less recently) was related to decreased odds
of lipodystrophy: OR 0.2 (95% CI 0.04-0.97); p=0.03. These results were confirmed in multivariable analysis adjusted for sex, CDC group, HIV-RNA value and
measures of adherence and quality of life. However, in patients who reported a
duration of lipodystrophy > 36 months, associations with adherence were small
and not significant.
Conclusions: Greater adherence was related to a higher probability of having
lipodystrophy. However, in patients with longstanding lipodystrophy, this relationship was not present. It is possible that lipodystrophy could result in decreased
adherence.

Presenting author: Giovanni Guaraldi, Clinica Malattie Infettive, via del Pozzo,
71, 41100, Modena, Italy, Tel.: [phone], Fax: [phone], E-mail:
g.guaraldi @ unimo.it