Kaiser Daily HIV/AIDS Report Highlights Recently Released Journal Articles
The following highlights recently released journal articles on HIV/AIDS.
- "Less Than 95% Adherence to Nonnucleoside Reverse-Transcriptase Inhibitor Therapy Can Lead to Viral Suppression," Clinical Infectious Diseases: David Bangsberg, associate professor of medicine at the University of California-San Francisco, analyzed HIV viral load suppression, defined as fewer than 400 copies per milliliter, in relation to treatment adherence for 110 HIV-positive adults living in San Francisco who were enrolled in the Research on Access to Care in the Homeless study from July 1996 through April 2000. Among the participants, 56 were treated with protease inhibitors -- indinavir, nelfinavir, ritonavir or saquinavir -- and 54 were treated with non-nucleoside reverse-transcriptase inhibitors -- efavirenz or nevirapine -- for an average of 9.1 months. The study finds that a majority of the reverse-transcriptase inhibitor group had suppressed viral loads if they took between 54% and 100% of their pills, while only members of the protease inhibitor group who had 95% or greater adherence achieved viral load suppression. Viral load suppression was significantly higher for the reverse-transcriptase inhibitor group than the protease inhibitor group, especially for patients with between 53% and 74% treatment adherence, the study says. Although Bangsberg writes that the study has several limitations, he concludes that the research provides "evidence that patients with moderate levels of adherence may also do well while receiving potent antiretroviral therapy" (Bangsberg, Clinical Infectious Diseases, 10/1). In a related commentary, Roy Gulick, associate professor of medicine at Weill Medical College of Cornell University, writes that the antiretroviral treatment "goal[s]" are "best accomplished with (near) perfect adherence," but recent data based on reverse-transcriptase regimens "reassure us" that current regimens "can tolerate some degree of imperfect adherence while maintaining the beneficial effects of HIV therapy in most patients" (Gulick, Clinical Infectious Diseases, 10/1).
- "Antiretroviral Medication Errors Among Hospitalized Patients With HIV Infection," Clinical Infectious Diseases: Darius Rastegar and colleagues evaluated the number of medication errors occurring among HIV-positive people receiving highly active antiretroviral therapy who were admitted to a single hospital over one year. The researchers reviewed the medical records of all HIV-positive people admitted to the hospital using Department of Health and Human Services guidelines to identify potential errors. The study finds that among 209 HIV-positive people admitted to the hospital, 61 uncorrected errors -- errors that were not fixed after 24 hours of entry -- occurred among 54 admissions, accounting for 25.8% of admissions. According to the study, errors in frequency of antiretroviral drug dosage occurred in 34 (16.3%) admissions; errors in combining antiretrovirals with a contraindicated medication occurred in 12 (5.2%) admissions; errors in the number of different antiretrovirals received occurred in 8 (3.8%) admissions; and 7 (3.3%) of HIV-positive people admitted experienced delays in receiving antiretrovirals. According to the researchers, HIV-positive people receiving HAART are "at substantial risk for antiretroviral medication errors at the time of hospitalization. More needs to be done to ensure that these patients receive appropriate therapy during their inpatient stay" (Rastegar et al., Clinical Infectious Diseases, 10/1).
- "Was the 'ABC' Approach (Abstinence, Being Faithful, Using Condoms) Responsible for Uganda's Decline in HIV?" PLoS Medicine: Although Uganda's "successes over the course of the HIV/AIDS epidemic must not be overlooked," abstinence "was not the primary focus of the public health campaigns" in the country during the 1990s, Elaine Murphy, scholar-in-residence at the Population Reference Bureau, and colleagues write in a PLoS Medicine debate feature. Murphy and colleagues say that researchers "still don't know the most effective strategy for decreasing the number of new cases of HIV in Africa," but "[g]iven the lack of evidence underpinning the abstinence strategy in the first place, it is crucial that condom use and education be emphasized" for the President's Emergency Plan for AIDS Relief to reach its target of preventing seven million new HIV cases by 2010. "The sooner we confront HIV/AIDS as the multifaceted and complex issue it is, the sooner we can make important steps towards progress in HIV prevention," Murphy and colleagues conclude (Murphy et al., PLoS Medicine, September 2006).
- "Predicting the Epidemiological Impact of Antiretroviral Allocation Strategies in KwaZulu-Natal: The Effect of the Urban-Rural Divide," Proceedings of the National Academy of Sciences: Sally Blower of the University of California-Los Angeles and colleagues used computer based models and assessed three potential antiretroviral drug allocation programs in the South African province of KwaZulu-Natal to determine which strategy would prevent the largest number of new HIV infections and deaths from AIDS-related illnesses, Reuters reports (Fox, Reuters, 9/12). The study finds that out of the three strategies -- one providing antiretrovirals only to the city of Durban and two others that would make them available in both urban and rural areas -- the "city-only" program would have the greatest impact on the epidemic, reducing the number of new HIV infections by 46%, or 15,000 new HIV cases, by 2008 (Xinhua/People's Daily, 9/12). In addition, in the city-only program, deaths from AIDS-related illnesses would decrease by 42% by 2008, the study finds. According to the researchers, if antiretrovirals were shared between Durban and rural areas, new HIV infections would fall by 11% to 28% in the city and 17% to 37% in rural areas (Reuters, 9/12). According to Blower, the city-only approach is the most effective, but "you can't have the maximum impact on the epidemic and be ethical." She added that a city-only antiretroviral provision program would lead to greater urban-rural health care disparities (Xinhua/People's Daily, 9/12).