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

XIV International AIDS Conference

Abstracts WePeB5873-WePeB5876 49

Results: The test standardized with normal human serum supplemented with
each drug and showed very good agreement with expected levels. Specimens
from treated patients were sent to a reference laboratory and close agreement
was found. Examples for Levoprin-ZG and LCMS respectively: Nelfinavir (pg/ml):
4.25 vs 4.00; 1.72 vs 1.73; 3.79 vs 4.58; 0.36 vs 0.32; 2.58 vs 1.73. Saquinavir
(pg/ml): 0.11 vs 0.14. Levels in in some patients may have been influenced by
the M8 metabolite, as previously described.
Conclusions: We describe a rapid method, Levoprin-ZGTM, which could be used
close to the point of care to measure the overall level of PI in patient serum,
yielded results similar to those obtained by LCMS. We propose that measurement of total protease inhibitory capacity may be adequate for routine clinical use
for TDM and for objective testing of adherence.
Presenting author: Marius Teodorescu, 2201 W Campbell Pk Dr, Chicago IL,
60612, United States, Tel.: [phone], Fax: [phone], E-mail: oana
@uic.edu
WePeB5873 Adherence education targeting selected
HIV-infected patients is effective: Evaluation of an
Institutional pilot program
A. Ashraf, J. Masci, M. Policar, R. Kutwal-Sharma, A. McDonald, C. Cardonas.
Elmhurst Hospital, Mount Sinai School of Medicine, depatment of medicine,
elmhurst hospital 79-01 broadway elmhurst, new york, ny 11373, United States
Issues: The importance of adherence to antiretroviral therapy in the management
of HIV patients is well recognized. However, what remains subject to debate is the
best, economic way to achieve adherence.
Description: 'Project Adherence' is an educational pilot project developed by the
Infectious Diseases Division, Elmhurst Hospital Center, New York and designed
to promote the adherence to antiretroviral in the HIV-infected patients who failed
virologically and those who have shown poor compliance to clinic appointments.
134 patients enrolled in this program. Intense adherence education provided by a
team consists of a registered nurse with clinical experience in HIV; a pharmacist
specialized in antiretroviral and a HIV social worker. Six weeks of follow up result
were evaluated.
Lessons Learned: Out of 134 patients with documented virologic failure 95 patients (70.8%) had virologic improvement after six weeks of adherence education.
47 patients (35%) achieved HIV-1 RNA (VL) suppression less then 400 copies/ml.
14 patients (10.4%) had greater than 1 log reduction in VL (excluding those who
achieved VL less than 400 copies/ml). 34 patients (25.3%) had less than 1 log reduction in VL. 39 patients (29.1%) had rebound in VL. Whether the cause of this
failure was due to non-adherence or development of resistant is not known at this
time. These findings suggest that an adherence education program dedicated to
a select group of HIV-infected patients is effective. This approach maybe more
practical and economic than providing it to all HIV-infected patients.
Recommendations: Institutions or clinics providing HIV care should consider
implementing an adherence education program. Targeting a select group of HIVinfected patients at high risk for non-adherence maybe an economic approach.
Presenting author: amar ashraf, depatment of medicine, elmhurst hospital, 79 -01 broadway, elmhurst, new york, ny 11373, United States, Tel.: [phone],
Fax: [phone], E-mail: ashraa01 @doc.mssm.edu
WePeB5874 Adherence to co-trimoxazole prophylaxis and ARV
therapy among HIV infected children in Kampala
RP.B. Bakaki1, H. Kisakye1, N.G. Pakker', D.H. Bray2, C. Ndugwal, F.A. Mmirol,
J.M.A. Lange3. IMulago Hospital, MU-JHU research house, PO BOX 23491,
Kampala, Uganda; 2 GSK, Middlesex, United Kingdom; 31ATEC, Amsterdam, The
Netherlands
Background: For successful long term viral suppression of HIV infection, at least
95% adherence to ARV is required. This high level of drug compliance may be
hard to achieve in developing countries where low adherence rates to other drugs
have been observed. The issue of adherence to ARVs in developing countries,
therefore, needs to be addressed. In children adherence is influenced by factors
related to both the child and the caretaker.
Methodology: Thirty pre-school HIV infected children who were involved in the
PETRA clinical trial in Kampala have been on co-trimoxazole (CTX) prophylaxis
for 3 years and ARV therapy (AZT and 3TC (BID syrup) and chloroquine (CO,
once weekly tablet)) for 9 months. The ARVs are dispensed at week 0, 2, 6, 12
and then every 12 weeks. To investigate adherence and factors influencing adherence, a pre-coded questionnaire was completed by the caretakers at 6 and
24 weeks after start of ARV therapy. Good adherence (95%) was defined as on
average having missed less than 1 dose per week.
Results: 31 and 25 questionnaires were completed at 6 and 24 weeks, respectively. Good adherence was observed in 80.6% (week 6) and 52% (week 24) of
the children. The most frequently missed drugs were AZT and 3TC. At week 6,
42% and 32% of the caretakers reported a missed dose since the week 2 visit for

AZT and 3TC. For CQ and CTX this was 16% and 19%. At week 24, 48%, 40%,
36% and 36% of the caretakers reported a missed dose since the week 12 visit
for AZT, 3TC, CO and CTX. The main reasons for missing drugs were; Caretaker
being away, forgetting, child's sickness or refusal to take drugs and running out of
medicine.
Conclusion: Good adherence to CTX prophylaxis and ARV therapy among preschool HIV infected children is hard to maintain. Since factors influencing drug

compliance are diverse, adequate monitoring and individualized advise to the patient or caretaker is needed.
Presenting author: Paul Bakaki, MU-JHU research house, PO BOX 23491,
Kampala, Uganda, Tel.: [phone], Fax: [phone], E-mail: n.pakker
@amc.uva.nl
WePeB5875I Usual care antiretroviral (ART) adherence
counseling practices of generalist versus
specialist physicians in North Carolina
C.E. Golin', S. Smith2, S. Reif3. 1University of North Carolina Schools of
Medicine and Public Health, UNC Sheps Center for HSR, 725 Airport Road,
Suite 208, Chapel Hill, NC 27599-7590, United States; 2University of North
Carolina School of Pharmacy, Chapel Hill, United States; 3 University of North
Carolina School of Public Health, Chapel Hill, United States
Background: U.S. guidelines recommend that physicians routinely enhance
HIV+ patients' ART adherence but the extent to which doctors do this is unknown.
Methods: We mailed a self-administered survey to all the physicians (MDs) in NC
who had prescribed a protease inhibitor (PI) in the prior year per a commercial
prescription-tracking database. Among the 589 surveys going to living MDs, 369
responded (63%). The 190 who reported prescribing a P1 in the last year made
up the study sample and answered questions about how often they carried out
each of 16 adherence counseling tasks as well as their demographics, practice
characteristics and attitudes.
Results: The majority were white, middle-aged men caring for a median of 10
HIV+ pts (range 0-1200) with 36% in an academic center; 25% were infectious
disease specialists (IDs), 37% general internists (GEN), and 28% family doctors
(FP). IDs cared for significantly more HIV+ pts than GEN/FPs and were more often from urban, academic practices with more time allocated to see HIV+ pts. On
average, MDs spent 13 mins counseling their pts for a new 3-drug ART regimen
and performed 8 of 16 adherence-counseling tasks most or all of the time. Tasks
most commonly performed (93-94%) were "explain the dose", "ask pt concerns"
and "explain drug resistance"; least commonly performed (38-42%) include: "help
pt plan dose times" and "help pts develop strategies to remember to take ART."
IDs spent the same amount of time counseling about adherence but performed
significantly more counseling tasks than GEN/FPs (10.0 vs. 7.6, p < 0.0001).
MDs who conducted more adherence tasks also were significantly more likely to
care for more HIV+ pts, have more time allocated to see HIV+ pts, and perceive
they had adequate time, space, skill and reimbursement to counsel (p < 0.05).
Conclusion: U.S. MDs conduct basic but not more sophisticated ART adherence
counseling. ID specialists perform more in depth adherence counseling than do
generalists.
Presenting author: Carol Golin, UNC Sheps Center for HSR, 725 Airport Road,
Suite 208, Chapel Hill, NC 27599-7590, United States, Tel.: [phone], Fax:
[phone], E-mail: [email protected]
WePeB5876 Pilot study of the effects of HAART + hydroxyurea
(HU) and Interleukin-2 (IL-2) administered at
primary HIV-1 infection (PHI)
A. Lafeuillade1, E. Counillon2, G. Hittinger', S. Chadapaud', C. Poggi1,
P. Deljiudice2, A. Kiazand3, D. Emilie4. General Hospital, Unite infectiologie,
Hospital Chalucet, 83056 Toulon, France; 2General/Hospital, Frejus, France;
3General Hospital, Draguignan, France; 4INSERM Institut Paris Sud des
cytokines, Clamart, France
Background: to evaluate the impact of combining HAART and non-specific immune interventions at the stage of acute infection.
Method: 18 patients with symptomatic PHI and no more than 3 bands on Western blot at entry received a combination of stavudine, didanosine, nelfinavir,
saquinavir at standard doses for 24 months (M). HU (500 mg bid) was added
from M3 to M24 and 2 courses of sub-cutaneous IL-2 (3 MUI bid for 6 consecutive days) were administered between M15 and M18. Three cycles of complete
therapy interruptions were planned after M24 and HAART resumed when plasma
HIV-1 RNA was >5000 copies/ml two times a week apart or >50000 copies/mi at
least once.
Results: at baseline, median age was 34 years, median viremia: 5.7 log
copies/ml, median CD4: 456/1L, median CD8: 998/1L, median proviral DNA: 3.6
log copies/million PBMC, 8 patients presented resistance mutations on the RT
and/or PR genes sequenced from baseline plasma RNA, including 1 with a multidrug resistant strain. In this case only the studied regimen did not provide viral
suppression <20 copies/mI until a change was done guided by phenotypic tests.
In December 2001, the mean follow-up of this series was 17 months. CD8 cells
decreased with therapy and CD4 cells slightly increased due to expansion of the
CD45RA subset only. A median drop of -2.3 log in proviral DNA level was found
in patients having reached M24. Seven patients have already stopped therapy on
1-2 occasions after M24: viremia remained <400 copies/mI in 3 cases, fluctuated

between 500-5000 copies/mi in 2 and rebounded permanently >50 000 copies/ml
in the last 2 cases (mean follow-up: 6 months). This evolution was closely related
to the presence of a specific anti-p24 CD4 proliferative response at M24.
Conclusion: an aggressive regimen administered at the time of PHI is susceptible to induce a sustained viral control in most patients after therapy discontinuation.