K. Maher et al., Disease progression, adherence, and response to protease inhibitor therapyfor HIV infection in an urban Veterans Affairs Medical Center, J ACQ IMM D, 22(4), 1999, pp. 358-363
Indinavir therapy has demonstrated promise in the treatment of HIV-I infect
ion in clinical trials; however, its efficacy in a U.S. Veterans Affairs Me
dical Center, where access to therapy is generally unimpeded, is unknown. A
review of the Miami cohort was conducted for the year beginning May 1996 t
o evaluate response to indinavir plus two nucleoside analogues. Of 483 HIV-
1-positive patients (97% male; mean age, 46.7 +/- 9.7 years), 266 were offe
red indinavir based on their having CD4 counts <200 cells/mu l or viral loa
ds >10,000 copies/ml. Of these patients, 36% were adherent and experienced
significant reductions in viral loads (-93,325 +/- 147,911 copies/ml) and e
levations in CD4(+) (111 +/- 103 cells/mu l) and CD8(+) (225 +/- 338 cells/
mu l) T cell counts. Adherent patients with baseline CD4 counts <100 cells/
mu l were 4.5 times more likely to have follow-up viral loads >10,000 copie
s/ml than those with CD4 >200 cells/mu l. Adherent patients with CD4 counts
<100 cells/mu l did not show evidence of immune "exhaustion" because they
were equal to those with CD4 counts >200 cells/mu l in their capacity to re
plenish CD4 cells. Nonadherence to the regimen resulted in loss of therapeu
tic benefit and suggested that strategies to enhance adherence may become a
n essential component of treatment.