Evaluating supervised haart in late-stage HIV among drug users: A preliminary report

Abstract

Objective. To examine response to highly active antiretroviral therapy (HAART) among a sample of treatment-experienced patients in the late stage of human immunodeficiency virus (HIV) infection in residential health care facilities (RHCFs) in New York City facilities designated for HIV/AIDS (acquired immunodeficiency syndrome) when access and adherence are maximized. Methods. Medical record review of 111 patients.Results. Demographics were mean age 42 years; 58% male; 60% African-American; 31% Hispanic; 57% injection drug users (IDUs); 23% with history of dementia; 52% hepatitis C virus (HCV) antibody seropositive; 80% on HAART, of whom 18% had lipodystrophy. Of 88 patients on HAART, 52% had a decreased viral load (> 89 log) versus 13% of 23 not on HAART (P < .05); a > 89 log viral load increase was seen in 8% and 35%, respectively (P < .05). Those with viral load increase were more likely than those with stable/decreased viral load to be IDUs (71% vs. 64%) and to have HCV seropositivity (86% vs. 53%), even with similar initial CD4* cell count, viral load, and follow-up time.Conclusion. In a predominantly minority IDU population who are treatment experienced, 50% of the patients successfully responded to treatment with supervised therapy. The RHCFs in New York City provide a unique opportunity to examine further factors associ- ated with response to HAART in an environment in which medication administration and adherence are maximized and monitored carefully.

The relationship between genotypic sensitivity score and treatment outcomes in late stage HIV disease after supervised HAART

“…All patients with an AIDS diagnosis [CDC, 1992], initiating or continuing ARV therapy, and with HIV-1 RNA levels !1,000 copies/ml at admission to the facility were enrolled into the study [The Supervised HAART Study, Greenberg et al, 1999]. Participants were followed at 1, 2, 3, 6, and 9 months after admission.…”

Directly Observed versus Self-administered Antiretroviral Therapies: Preference of HIV-Positive Jailed Inmates in San Francisco

“…[13][14][15] However, there are concerns regarding lack of confidentiality and stigma, [16][17][18][19] as well as sustained benefits of DOT after release from correctional facilities, when patients must transition to self-administra-tion of medications. Data show that the proportion of those who continue ARVs immediately after release is low, 16,[20][21][22][23][24] which is particularly important, as the postrelease period is a time of high-risk behaviors.…”

Pilot Study to Enhance HIV Care Using Needle Exchange-Based Health Services for Out-of-Treatment Injecting Drug Users

“…40 Rates of nondetectable viral load in patients receiving HAART in clinical care settings average [41][42][43] around 50%. While DOT has been demonstrated to provide a structural intervention for the treatment of tuberculosis, 1,44 limited feasibility has been demonstrated for the management of HIV outside highly structured correctional, 39,40 skilled nursing, 45 and methadone maintenance settings. 46 Modified directly observed therapy (mDOT) has been suggested, but feasibility has yet to be demonstrated in community settings.…”