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

38 Abstracts WePeB5825-WePeB5828

XIV International AIDS Conference

Abstract WePeB5827 - Table
N=653 Non-adherent PTS Non-adherent PTS Adherent PTS Adherent PTS P
Non-adherent PHY Adherent PHY Non-adherent PHY Adherent PHY Linear trend
% of pts with undetectable plasma HIV RNA 62 70 71 77 0.001
% of pts with detectable PI plasma concentration 81 91 93 96 <0.001

WePeB5825 Adherence in a nutrition chemoprevention trial:
Gender differences
G. Shor-Posnerl, G. Moreno-Black2, M.J. Miguez', N. Rodriguez 1,
X. Burbanol, R. Lecusay', M.K. Baum3. 'University of Miami School of
Medicine, University of Miami School of Medicine, Dept of Psychiatry (D21),
1400 N.W 10th ave., 6th floor, United States; 2University of Oregon, Eugene,
United States; 3Florida International University, Miami, United States
Background: Adherence and retention are major challenges researchers face
when conducting randomized clinical trials. The data presented here include information from the first nutritional chemoprevention trial in HIV+ drug users.
Methods: 234 HIV+ drug users (51% male, 49% female) were enrolled in a randomized, double-blind, placebo-controlled trial and followed longitudinally (1998 -2000). Pills were dispensed monthly, and patients evaluated every 6 months. This
analysis includes those adherent participants (n=186) who attended monthly evaluations and completed the six-month visit.
Results: Men were twice as likely as women to dropout of the study (95%CI
1.126-4.558, p=0.02). Viral load levels were higher but not statistically different, in
the women (57727~137362) than the men (48327~120369) and CD4 cell counts
were similar in both groups (W 423~309 vs. M 356~259). Age was a significant
factor influencing participation in the women, but not the men, with older women
being more likely to continue in the study (p=0.05). While men who lived in a
shelter or were homeless were 3x more likely to drop out than men who lived at
home (95% CI 1.309- 6.8777, p=0.008), none of the women who lived in a shelter
dropped out of the study. Cocaine use was reported in 58% of the men and 31%
of the women, and male cocaine users tended to be twice as likely to dropout as
male non-users (p=0.06).
Conclusions: Although the overall rate of participation was high, gender differences in adherence were evident and influenced by age, drug use and living
situation, underscoring the necessity to view adherence as a multidimensional
experience. Support: NIH-Fogarty and NIDA.
Presenting author: Gail Shor-Posner, University of Miami School of Medicine,
Dept. of Psychiatry (D21), 1400 N.W. 10th ave., 6th floor, United States, Tel.:
[phone], Fax: [phone], E-mail: [email protected]
WePeB5826 Psychosocial predictors of medication adherence
among HIV-infected youth
S.G. Hosek', G.W. Harper2, R. Domanico'. 'Cook County Hospital, 1005 W
Dickens Ave., Chicago, IL, United States; 2DePaul University Chicago, United
States
Background: This purpose of this study was to examine the rates of medication adherence among HIV-infected adolescents/young adults and to explore the
relationship between negative affect, cognitive ability/formal reasoning, and substance use on the medication adherence of these youth.
Methods: Forty-two HIV-positive youth (25 males, 17 females; age range 16-24)
currently taking antiretroviral medications were recruited from the CORE Center,
an outpatient healthcare facility that provides services for individuals living with
HIV infection, to participate in a one-hour interview.
Results: Using the time-line follow-back calendar method, sixty-six percent of
participants had missed a dose of medicine in the past week while 42% missed
a dose "yesterday." The participants' self-reported reasons for missing medication doses will be presented. Rates of negative affect, including depression, anxiety, and hopelessness, will also be presented along with rates of substance use.
Multiple regression analyses demonstrated that both depression and age of first
marijuana use were statistically significant predictors of non-adherence (p<.01,
R2 = -0.326). Specifically, higher rates of depressive symptoms and younger age
of first marijuana use predicted lower rates of medication adherence. Developmentally, 69% of the sample had yet to begin the transition from concrete thinking
to formal or abstract reasoning.
Conclusions: The results from this project demonstrate that adherence to antiretroviral medications continues to be a problem with HIV-infected youth. These
results are an important first step toward the development of interventions aimed
at increasing medication adherence among adolescents and young adults living
with HIV. A pilot adherence intervention study currently underway with these youth
will be discussed.
Presenting author: Sybil Hosek, 1005 W. Dickens Ave., Chicago, IL, United
States, Tel.: [phone], Fax: [phone], E-mail: shosek@depaul.
edu

WePeB5827 Relation between patients' self-reports,
physicians' assessment of adherence and PI
plasma concentration in HAART-treated patients
B. Spire', G. Peytavin2, S. Duran', F. Raffi3, J.L. Ecobichon4, E. Pereira5,
V. Cailleton', H. Portier6, D. Sicard7, J.P. Moatti1. 'INSERM U379, INSERM
U379, 23 rue Stanislas Torrents, 13006, Marseille, France; 2Faculte Xavier
Bichat, Paris, France; 3Nantes Hospital, Nantes, France; 4Faculte X Bichat,
Paris, France; 5 INSERM U330, Bordeaux, France; 6Dijon Hospital, Dijon,
France; 7Cochin Hospital, Paris, France
Objective: To compare patients' (pts) self-reports about adherence with prescribing physicians' assessment and to study their relationship with PI plasma concentration and HIV RNA. Among the 861 pts who were started on 2 nucleoside analogues + one PI: blood sampling of the French multi-center APROCO cohort, pts'
self-reports about adherence (PTS) and physicians' evaluation of pts adherence
(PHY) at 4 month of follow-up were available for 653 pts. PI plasma concentration, measured using high performance liquid chromatography, was interpreted
as undetectable level according to the limit of detection (respectively 5, 3, 3 and
9 ng/ml for IDV, RTV, NFV and SQV). Statistical analysis was performed using
Chi-square test for linear trend.
Results: 55% pts reported 100% of adherence, while 54% of pts were perceived
as totally adherent by their physician. However, pts' reports and physicians' assessment were only concordant in 63% of cases (Kappa=0.25). Proportions of pts
with undetectable viral load and with undetectable PI concentrations according to
the 'category' of assessment are shown in the table above.
Among pts with discordant data the proportion of pts with undetectable viral load
and detectable PI concentration was similar.
Conclusions: Cross-validation of various approaches appears to be a useful tool
for better accuracy in assessment of pts' non-adherence. Furthermore, as they do
not evaluate similar period of time, they provide complementary information.
Presenting author: Bruno Spire, INSERM U379, 23 rue Stanislas Torrents,
13006, Marseille, France, Tel.: [phone], Fax: [phone], Email: spire@ marseille.inserm.fr
WePeB5828 Predictors of Medication Adherence in HIV/AIDS
C.H. Hinkin', S.A. Castellon', D.J. Hardy2, M.N. Lam', M. Stefaniak2,
T Farchione2, M. Ropacki2, D. Thrasher2, K. Mason2, R. Schug2,
R.S. Durvasula3. 1UCLA Dept. of Psychiatry & VA Greater Los Angeles
Healthcare System, UCLA NP/ C8-747, 760 Westwood Plaza, Los Angeles, CA,
90024, United States; 2UCLA Department of Psychiatry Los Angeles, United
States; 3Caifornia State University Los Angeles, Los Angeles, United States
Background: Although medication adherence is multi-determined in nature, few
studies have attempted to simultaneously examine diverse objective predictors.
This study investigated the relationship of neuropsychological (NP) impairment,
psychiatric disorder, drug/alcohol abuse, and psychosocial constructs such as
health beliefs in the prediction of adherence to antiretroviral therapy.
Method: Participants consisted of 142 HIV+ adults, 76% of whom met diagnostic
criteria for AIDS. Medication adherence was determined using electronic monitoring (MEMS caps) to measure HAART adherence over 1 month. Participants
who took at least 90% of prescribed doses were classified as good adherers. All
participants completed a battery of NP tests, measures of psychiatric symptoms
including drug/alcohol abuse, and measures of medical decision making (e.g.,
health beliefs/locus of control).
Results: A series of logistic regression analyses revealed age to be a strong predictor of medication adherence; participants age 50 or older were 4.6 times more
likely to be classified as good adherers [0=1.52, p<.001]. After controlling for age
and education, participants classified as NP impaired were 2.5 times more likely
to be non-adherent [P=.92, p=.04]. Current drug abuse, but not alcohol abuse,
was strongly associated with poorer adherence [P=1.64, p=.02]. Neuropsychiatric dysfunction was associated with a 4-fold greater risk of adherence failure
[ n=1.39, p=.002]. Among measures of health beliefs, only utility was predictive of
medication adherence. Medication adherence was also associated with intention
to adhere and self-efficacy.
Conclusion: These data demonstrate that HAART adherence is associated with
multiple variables including NP impairment, drug abuse, neuropsychiatric disorder, and specific health beliefs and intentions. As such, interventions designed to
improve medication adherence must address a multiplicity of factors.
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]