Disease progression, adherence, and response to protease inhibitor therapyfor HIV infection in an urban Veterans Affairs Medical Center

Citation
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
Citations number
24
Categorie Soggetti
Clinical Immunolgy & Infectious Disease",Immunology
Journal title
JOURNAL OF ACQUIRED IMMUNE DEFICIENCY SYNDROMES
ISSN journal
15254135 → ACNP
Volume
22
Issue
4
Year of publication
1999
Pages
358 - 363
Database
ISI
SICI code
1525-4135(199912)22:4<358:DPAART>2.0.ZU;2-O
Abstract
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.