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

XIV International AIDS Conference

Abstracts WePeB5829-WePeB5833 39

WePeB5829 Simplified antiretroviral therapy with zidovudine,
lamivudine and abacavir as salvage therapy for
heavily non-adherents patients
H. Knobel1, A. Guelar1, G. Vallecillo1, A. Carmona2, A. Gonzalez', P Saballs1,
S. Marco3. 1Dept. Infectious Diseases. Hospital del Mar, Dept. Infectious
Diseases, Hospital del Mar, Paseo Maritimo 25-29, 08003 Barcelona, Spain;
2Dept. Pharmacy Hospital del Mar, Barcelona, Spain; 3Glaxo Smith Klein,
Madrid, Spain
Background: Non-adherence to antiretroviral therapy appears to be a strong predictor for virologic failure. Simplification strategies were explored in the setting of
an initial therapy and switching from a successful HAART This study evaluated
the effectiveness of a simplified regimen for heavily non-adherent patients who
had previously failed HAART.
Methods: We conducted a prospective open-label pilot study among
antiretroviral-experienced patients. Inclusion period: July 2000 to July 2001. The
treatment schedule was: CombivirTM+ AbacavirTM BID and switched to TrizivirTM
BID since it was licensed in Spain. Eligible patients had to have plasma HIVRNA > 5000 copies/ml, previous treatment containing 2 NRTIs + PI, severe nonadherence to the regimen (self reported less than 50% of prescribed doses in
the previous 3 months, or withdrawal from therapy). Genotype resistance studies
were performed at baseline in 20 patients. We present the results of the 24-week
follow-up.
Results: Baseline characteristics of the 50 enrolled patients: mean age 37 years;
72% male; mean viral load 4.3 log/ml; mean CD4 214 cells/ml; IDU: 84%;
methadone maintenance program 56% group C of CDC: 42%. Previous failures to
HAART: 1:48%, 2:36%, 3:14%, and 4:2%. No mutation associated to resistance
to NRTIs or PI was founded.
In the intention-to-treat analysis 44% of patients achieved viral load below 500
copies/mi (66.5% on-treatment). The mean viral load dropped 1.6 log (95% CI:
1.1-2.1) and the mean CD4 increased: 124 cells (95% CI: 59-179). Adverse
events were founded in 22%; mortality: 6%; lost of follow-up: 40%. Adherence
greater than 90% of prescribed drugs: 50% of patients.
Conclusions: In the setting of heavily non-adherent patients this simplified combination therapy containing 3 NRTIs obtained acceptable results on salvage therapy However, to improve them, more aggressive interventions in support of adherence are needed.
Presenting author: Hernando Knobel, Dept. Infectious Diseases, Hospital del
Mar, Paseo Maritimo 25-29, 08003 Barcelona, Spain, Tel.: [phone], Fax:
[phone], E-mail: [email protected]
WePeB5830 Adherence assessment among HIV infected
patients on antiretroviral therapy in Belo
Horizonte, Brazil:(2) Baseline Characteristics
P.RE. Bonolol, M.D.C. Guimaraes', G.M. Rochal, M.G.B. Ceccato2,
V.C.G. Veloso1, FA. Acurcio2. 1 School of Medicine, Federal University of Minas
Gerais, Belo Horizonte, Brazil; 2School of Pharmacy, Federal University of Minas
Gerais, Belo Horizonte, Brazil
Background: Behavioral and demographic characteristics may affect adherence
among patients undergoing antiretroviral(ARV) therapyTo describe baseline characteristics of patients initiating HIV treatment.
Method: Ongoing prospective study of HIV infected patients at two public AIDS
referral centers in Belo Horizonte, Brazil. Patients were interviewed immediately
after deliverance of first ARV prescription and at one and three months after beginning medication. Socio-economic, behavioral, and demographic characteristics were collected before initiating therapy.
Results: As of Nov, 2001, 256 patients had been recruited. Most patients were
>30 y.o.(67%), male(55%), single(50%), had < 8 years of education (56%), and
monthly income < US$170(73%). Among women, 35% initiated ARV to prevent
vertical transmission. Eighty-three percent reported multiple lifetime sexual partners while condom use was rarely or never used for 67%. It should be noted
that among those reporting sexual contact in the past month, 38% continued to
practice unsafe sex. Alcohol and tobacco use were reported by 35% in the past
month while 5% ever used injecting drugs. Most patients considered their ARV
treatment necessary(93%) and had triple drug regimen(92%) which included at
least one protease inhibitor(56%) as first prescription. Only 2% participated in
support groups.
Conclusion: 1.Risky behaviors before ARV treatment and socio-economic conditions (e.g. lower education and income) should be taken into account for developing intervention strategies to improve adherence; 2. It is high the proportion of
pregnant women under care in these centers; 3. Initial ARV regimens prescribed
are in accord with Brazilian National AIDS program.
Presenting author: Mark Guimaraes, Rua Alagoas 581 Apt 805, Bairro Funcionarios, Belo Horizonte, MG, 30130-160, Brazil, Tel.: [phone], Fax:
[phone], E-mail: drew@ medicina.ufmg.br

WePeB5831 Factors related to adherence to HAART in patients
in usual clinical follow-up
A. Tuldral, C.R. Fumazl, M.J. Ferrer1, R. Bayes2, A. Ballesteros', A. Bonjoch1,
A. Joul, E. Negredo1, J. Romeu', G. Sireral, C. Turall, B. Clotet'. 1Fundacid
L/uita SIDA-Univ Hosp Germans Trias i Pujol, FUNDACIO LLUITA SIDA,
HOSPITAL GERMANS TRIAS I PUJOL, CTRA DE CANYET S/N, 08916
BADALONA, Spain; 2Psychology Dept Universitat Aut6noma de Barcelona,
Bellaterra, Spain
Background: Correct adherence (ADH) to antiretroviral treatments (HAART) depends from a lot of factors. Some of them have been described in controlled
studies but information about this issue in patients in usual clinical follow-up is
scarce.
Methods: In a retrospective observational descriptive study, information contained in 1713 follow-up visits about ADH was analyzed: % of self-reported ADH,
intake conditions ADH, week of treatment, effort to follow HAART, self-perceived
capability to follow treatment (SC), health status believes, confidence in current
HAART, satisfaction with physician attention, lipodystrophy presence and worries
related to it, work state, current partner existence, family or near-people informed
about HIV status, worry about viral load (VL) changes, quality of life, support to
follow HAART, adverse events (AE), AE duration, CD4, VL, opportunistic infections, emotional status (POMS questionnaire). A logistic regression analysis was
performed to determine variables related to good ADH (395%).
Results: In the univariate analysis, ADH was related to intake conditions ADH
(p<0.001), less effort to follow HAART, (p= 0.009), less SC (p<0.001), higher
confidence in HAART (p=0.02), lipodystrophy (p=0.0013), to have a job (p=0.024),
family (p=0.057) or near-people (p=0.03) informed, AE duration (p=0.02), higher
CD4 recount (p=0.03), less VL (p=0.004), and better emotional status (p<0.001).
In the multivariate analysis, variables related to ADH were: intake conditions ADH
(p<0.001), less SC (p<0.001), less VL (p=0.017), and better emotional status
(p<0.05).
Conclusion: As observed in previous studies, the relation between ADH and VL
is confirmed. Personal variables as SC and emotional status might be specially
useful to monitor ADH in clinical practice.
Presenting author: ALBERT TULDRA, FUNDACIO LLUITA SIDA, HOSPITAL
GERMANS TRIAS I PUJOL, CTRA DE CANYET S/N, 08916 BADALONA, Spain,
Tel.: [phone], Fax: [phone], E-mail: [email protected]
WePeB5832 Incidence of the depressive symptoms in the HIV
disease
R.M. Solari1, A.E. Niding2. 1M.D, Pasaje El Totoral, No 987, Ciudad de Buenos
Aires, Argentina; 2Psychologist, Buenos Aires, Argentina
Introduction: the depressive symptoms would impact negatively in the course of
the HIV disease, reason why it arises the necessity of their study and evaluation.
Background: to determine the association between depressive symptoms and
CD4 count, viral load, adherence to the treatment (HAART), and the morbidity
and mortality for the HIV disease.
Material and methods: 28 patients were included, between 21 to 40 years, that
completed the following criteria: CD4 count >200/mm3, CV >35000 copies, they
had began HAART and they didn't accept psychological and/or psychopharmacological treatment. We divided them according to the scale of auto-evaluation of
the depression of the Dr. W.W. K. Zung, in normal (10 patients), slight to moderate
(8), moderate to intense (5) and intense depression (5). A clinical following was
carried out during a period of 12 months.
Conclusions: 90% of the patients without depression fulfilled HAART with therapeutic success; on the other hand, inside the group moderated to intense and
intense, the 100 and 90% abandoned the medication respectively. Opportunistic
infections were only registered in the groups with depressive symptoms. Studies
with more cohorts could confirm that the depression level has a direct relationship
with the adherence to the HAART and the progression of the illness, for what it
would be important its precocious diagnosis and therapy.
Presenting author: Ruben Marcelo Solari, Pasaje El Totoral, No 987, Ciudad de
Buenos Aires, Argentina, Tel.: [phone], E-mail: [email protected].
ar
WePeB5833 Acceptability, Tolerability and Adherence of short
course Antiretroviral therapy (ART) in primary HIV
infection (PHI)
Z.E. Sheppard1, M. Brady2, S. Fidler2, N. Tamm2, J.N. Weber2, S. Lamond1.
1Wharfside Clinic, St Marys Hospital, Paddington, United Kingdom; 2Faculty of
Medicine, Imperial College, London, United Kingdom
Background: Primary HIV Infection is an emotionally difficult period often accompanied by profound symptoms. The introduction of ART, with potentially complex
regimens, side effects and the need for rigid adherence may further confound

these difficulties. We report our experiences of treating a large cohort of patients
with PHI.
Methods: 43 patients with PHI have been recruited from St Mary's Hospital, London. All infections were sexually acquired (42 MSM and one heterosexual female). Patients were offered a choice of either a short course (12 weeks) of ART
or no therapy ART used was combivir/nevirapine but later in the study changed
to trizivir/efavirenz. All patients were seen regularly by both doctors and nurses.