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

Objective. To examine response to highly active antiretroviral therapy (HAA RT) among a sample of treatment-experienced patients in the late stage-of h uman immunodeficiency virus (HIV) infection in residential health care faci lities (RHCFs) in New York City facilities designated for HIV/AIDS (acquire d 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-Americ an; 31% Hispanic; 57% injection drug users (IDUs); 23% with history of deme ntia; 52% hepatitis C virus (HCV) antibody seropositive; 80% on HAART, of w hom 18% had lipodystrophy. Of 88 patients on HAART, 52% had a decreased vir al load (>1/2 log) versus 13% of 23 not on HAART (P < .05); a >1/2 log vira l 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 ti me. Conclusion. In a predominantly minority IDU population who are treatment ex perienced, 50% of the patients successfully responded to treatment with sup ervised therapy. The RHCFs in New York City provide a unique opportunity to examine further factors associated with response to HAART in an environmen t in which medication administration and adherence are maximized and monito red carefully.