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

XIV International AIDS Conference

Abstracts WePeB5838-WePeB5842 41

Washington St., Boston, MA 02111, United States, Tel.: [phone], Fax:
[phone], E-mail: [email protected]
WePeB5838 Impact of different HAART regimens on adherence
and durability of treatment: The Kaiserdamm
Cohort
A. Moll, S. Nzimegne-Goelz, G. Klausen, D. Schleehauf, D. Prziwara, C. Cordes,
J. Goelz. Praxiszentrum Kaiserdamm, Berlin, Germany
Background: To determine the influence of different HAART regimens on adherence, efficacy and durability of treatment among patients in the Kaiserdamm
cohort.
Methods: Retrospective analysis of antiretroviral therapy-naive patients initiating
different HAART regimen (2 NRTI + 1-2 PI or 2 NRTI + 1 NNRTI or 3 NRTI) between Jan 1996 to Dec 2000. We compared efficacy, adverse events, reasons for
treatment failure, adherence and duration of unchanged HAART between three
regimen types over 52 weeks.
Results: 270 ART-naive adults were enrolled, 145 receiving 2NRTIs/PI (Grp 1),
79 receiving 2NRTIs/NNRTI (Grp 2) and 46 receiving 3NRTIs (Grp 3).
Mode of infection: 69% homo/bisexual, 14% heterosexual, 11% IVDU, 6% Pattern II. At baseline 17% were categorized as CDC class A, 60% class B and 23%
class C. Median Baseline CD4 counts were 274, 331 and 342 cells/mm3 and
plasma HIV-1 RNA levels were 112,000,107,000 and 151,000 copies/mL in Grps
1, 2 and 3 respectively. 31/145 (21%), 40/79 (50%) and 33/46 (71%) of patients
in Grps 1, 2 and 3 respectively completed 52 weeks on their initial regimen.
Grp 1(n145) Grp 2(n79) Grp 3(n46)
adverse events 25% 18% 19%
non-daherence 12% 6% 2%
treatment interruption 5% 6% 2%
treatment failure 14% 11% 6%
switch to NRTI/NNRTI 16% 9% 0%
switch to 2 PIs 7% 0% 0%
median CD4 week 52 403 537 540
VL<50c/mL week 52 75% 91% 83%
Conclusions: 52 weeks after initiating therapy, 71% of patients receiving 3 NRTIs, 21% of patients receiving PIs and 50% of patients with a NNRTI containing
regimen did not change therapy,. The rate of therapy switches due to adverse
events are similar in all three groups (around 20%). Virological and immunological response at week 52 were similar in all three groups. The initial therapy with 3
NRTI (ZDV+3TC+ABC) showed the lowest rates for treatment changes and discontinuations compared to the PI- or NNRTI-containing regimen.
Presenting author: Joerg Goelz, Praxiszentrum Kaiserdamm, Kaiserdamm 24,
14057, Berlin, Germany, Tel.: [phone], Fax: [phone], E-mail:
[email protected]
WePeB5839 HIV patient's attitudinal differences may advise
more successful treatment programs
D. Bass1, T. Glennon1, M.A. Chesney2. 'Bristol-Myers Squibb Virology, 777
Scudders Mill Road, Plainsboro, NJ, United States; 2University of California, San
Francisco, Ca, United States
Background: HIV patients are often characterized by demographics or lifestyle
behavior, e.g. women, Hispanics, and Men Who Have Sex With Men. Research
suggests demographics alone are not predictive of behavior. Homogeneous patient sub-groups are better identified through shared disease/treatment related
attitudes which could advise more successful HIV treatment.
Methods: In mid 2001, surveys were completed by people with HIV (PWHIV) in
10 US cities with the highest incidence of HIV Sample reflected CDC prevalence
statistics. Topics included patient attitudes on healthcare, HIV disease/treatment,
and key demographics. Descriptive statistics summarized data and cluster analysis was applied to generate patient sub-groups.
Results: Four sub-groups of PWHIV were identified with the following defining
characteristics:"Thrivalists" (32%): feel very supported in dealing with HIV and
believe HIV has not affected their social lives. They strongly believe that if they
adhere to their doctor's advice, their health will benefit."Silent Copers" (20%): are
always seeking to make HIV invisible, and feel HIV negatively affects how they
view themselves. They are more likely to claim they always remember to take
medicine as prescribed."Emotionally Despaired" (16%): are more likely to agree
that HIV is the first thing they think of when they awake, HIV has caused missed
days of work, and they are not going to achieve their dreams because of HIV.
"Alienated Avoiders" (32%): take care of their children - so they have no time to
treat HIV and believe it's inconvenient to get medical care. There were no significant differences in demographics across sub-groups, but there were significant
differences for self-reported adherence, Alienated Avoiders being the least and
Silent Copers being the most.

Conclusion: Observed differences between patient sub-groups suggest that
providers should tailor treatment programs according to distinct patient attitudes
to enhance adherence.
Presenting author: Debra Bass, 777 Scudders Mill Road, Plainsboro, NJ, United
States, Tel.: [phone], Fax: [phone], E-mail: [email protected]

WePeB5840 Prior participation in clinical trials as a predictor of
virologic success in patients followed in a
specialized hiv clinic
J.G. Castro, M. Goicoechea, R. Monroig, M.G. Ale-castro. University of Miami,
1800 n.w. 10th ave, Miami, FL 33136, United States
Background: The rate of virologic control of antiretroviral regimens used in clinical trials (CT) is higher (70 to 90%) than the same regimes used in specialized
HIV clinics (50%). The reasons for such discrepancy are not well explored. The
objective of our study was to assess if patients who are followed in a specialized
HIV clinic who participated in a CT in the past, have better virologic control than
patients followed in the same clinic who never participated in CT
Methods: Subjects admitted to our clinic since Mach 2000 were divided in two
groups. Group A was composed of subjects who participated in a CT for antiretrovirals in the past. Group B was composed of subjects who never participated in
CT Data extracted from the medical records was transferred to a case report
form. Virologic control: HIV RNA < 400.
Results: At random we selected 60 subjects, 30 for each group. Group A average
age was 42 years, 37% females. Group B, average age 40 years, 23% females.
At baseline: Group A, 4 subjects had a CD4 < 200, and 7 were on virologic failure. Group B, 11 had a CD4 < 200, 16 were antiretrovirals naive, and 6 were on
virologic failure. Average length of follow up was 38 weeks (0 to 76) for Group A
and 39 weeks (0 to 74) for Group B. Major side effects present in 1 subject (Group
A) and in 6 (group B). There were 3 subjects lost in group A and 6 lost in group
B. In the last visit, there were 17/24 (71%) subjects on virologic control in Group
A and 3 subjects had a CD4 < 200. On the other hand, 18/24 (75%) subjects
in Group B were under virologic control, and 7 had a CD4 < 200. There were 5
patients in this group who did not start antiretrovirals.
Conclusion: For the subjects followed in our outpatient clinic, prior participation
in a clinical trial was not a marker for better virologic control.
Presenting author: Jose Castro, 1800 n.w. 10th ave, Miami, FL 33136, United
States, Tel.: [phone], Fax: [phone], E-mail: jgcastro@yahoo.
com
WePeB5841I Psychological distress, not alcohol or drug use,
associated with ART non-adherence
M.L. Ekstrand, G.M. Crosby, J. Paul, J. Martin, D. Bangsberg, R.D. Stall. UCSF,
Center for AIDS Prevention Studies, San Francisco, CA, United States
Background: Stringent ART adherence may be necessary to avoid the development of drug resistant virus. This paper examines rates and correlates of HIV
medication adherence in a sample of alcohol or illicit drug users.
Methods: These data are from the baseline assessment of the first 200 participants in a randomized, controlled adherence intervention trial. Participants are
HIV positive, on ART, have detectable viral loads and report some recent use of
alcohol or illicit drugs. Recruited primarily through bars, gyms, and health clinics,
they are assessed every 4 months by interview, self-administered questionnaire,
and serological tests.
Results: Most participants are male (90%) and gay/bi/lesbian (85%). This ethnically diverse sample is 54% Caucasian, 28% African American and 12% Latino.
In the prior 4 months, 49% reported never missing a medical appointment and
46% reported always following their treatment plan. During the last 4 days, 63%
reported taking at least 95% of their medication and were considered "adherent".
In bivariate analyses, non-adherent subjects reported more reasons for missing
doses (p<.0001), were more likely to be depressed (p<.04), had less structure in
their daily lives (p<.03), felt more helpless/overwhelmed/burned-out (p<.02), and
felt less able to manage or control medication side effects (p<.02). Adherence
was not related to level of alcohol consumption, type of illicit drugs used, or to any
demographic factors.
Conclusions: Substance-using HIV positive individuals on ART are in need of
adherence interventions that incorporate side effects management skills. Since
non-adherence was related to a lack of personal organization or unstructured
lives, they may also need to develop structure in their daily lives and to tailor regimens to daily activities when possible. As lack of adherence was also associated
with psychological distress, screening and providing mental health referrals may
indirectly help to improve medication adherence.
Presenting author: Maria Ekstrand, Center for AIDS Prevention Studies, Suite
600, 74 New Montgomery Street, San Francisco, CA 94105, United States, Tel.:
[phone], Fax: [phone], E-mail: [email protected]
WePeB5842 Long-term adherence with nucleoside reverse
transcriptase inhibitor (nrti) therapy
C.M. Dezii1, B. Burtcel1, S. Hodder1, S. Grandy', H. Kawabata2. iBristol-Myers
Squibb ViroogyPlainsboro, NJ, United States; 2Bristol-Myers Squibb Outcomes
Research, P/ainsboro, N J, United States

Background: Significance of the relationship of adherence and virologic success
has been well documented in the HIV treatment arena. Few studies, if any, exist
examining adherence over an extended period of time from initiation of antiretroviral therapy (ART).
Methods: Retrospective analysis of California Medicaid (Medi-Cal) administrative claims data from 3Q 1994 to 2Q 2000 was conducted. Patients were ART
free for one year prior to the first NRTI prescription (index date) to establish new