Study reveals importance of adhering to the drug regimen for AIDS patients
Posted by Dave on February 9, 2010 | 7 Comments
Yesterday I mentioned that a key aspect of fighting AIDS is staying on the drug regimen. Charles pointed out that this is more difficult than it might seem: the drugs are constant reminder of your condition, and taking them can revive horrible memories.
But how important is it to maintain adherence to the regimen? A 2008 study shows just how important it can be. A team led by Gregory Bisson studied medical records of records of 1,982 AIDS patients in south Africa to find out how adherence to combination antiretroviral therapy (cART) correlates to actual health outcomes. In developed countries, patients are regularly tested for T-cell count and viral load. Charles gets these tests quarterly; they are an important indicator of how well he’s doing. A T-cell count below 350 is normally cause for alarm, as is a viral load above 1,000 copies per ml of blood.
But T-cells generally dip only after the virus has begun replicating, so viral load is perhaps the most important indicator of the progression of the disease. Unfortunately, this is also the most expensive test, so in developing countries, medical staff often make do with just a T-cell count, or even no test at all.
Given the importance of cART drug adherence, Bisson’s team wondered if monitoring a patient’s drug intake could make a reasonable substitute for the T-cell and viral load test. Could it be that just looking at the drugs a patient purchased was as valuable as the laboratory tests?
Each patient in the sample was followed for a year, and tracked to see if they experienced virologic failure—a viral load over 1,000—during the course of the study. Their T-cell counts were also monitored. Did drug adherence predict virologic behavior? Here are the results:
The graph on the left shows patients with no virologic failure, and the graph on the right shows patients with virologic failure. Each dot represents a single patient. The vertical axis shows their refill adherence over the course of the year: the portion of the time each patient picked up his or her prescription.
As you can see, those with no virologic failure are clumped at the top of the graph, with the vast majority claiming their drugs more than 80 percent of the time. By contrast, few people who took more than 80 percent of the drugs experienced failure. In fact, cART adherence was a better predictor of virologic failure than T-cell count. If a clinician had to choose between closely monitoring T-cell levels and prescription adherence, they would be better off choosing prescription adherence.
That’s how critical it is to keep taking the antiretroviral drugs once you’ve been diagnosed with aids; even dipping below an 80 percent adherence level dramatically increases the chances of the virus making a comeback. Once it does, the chances that it will be in a mutated form, immune to therapy, is considerably greater, and the odds of survival diminish.
Bisson, G., Gross, R., Bellamy, S., Chittams, J., Hislop, M., Regensberg, L., Frank, I., Maartens, G., & Nachega, J. (2008). Pharmacy Refill Adherence Compared with CD4 Count Changes for Monitoring HIV-Infected Adults on Antiretroviral Therapy PLoS Medicine, 5 (5) DOI: 10.1371/journal.pmed.0050109
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February 9th, 2010 @ 3:12 pm
Today’s Daily Monthly: Study reveals importance of adhering to the drug regimen for AIDS patients http://is.gd/824Qr
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February 9th, 2010 @ 3:15 pm
Study reveals importance of adhering to the drug regimen for AIDS patients http://goo.gl/fb/34az
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February 9th, 2010 @ 4:08 pm
Study reveals importance of adhering to the drug regimen for AIDS patients http://goo.gl/fb/lcwZ
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February 9th, 2010 @ 6:33 pm
Study reveals importance of adhering to the drug regimen for AIDS patients http://bit.ly/beu2rN
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February 10th, 2010 @ 2:40 am
هذا الرجل يعرفُ طريق المرمى جيّداً! http://www.youtube.com/watch?v=q0rmQYf8mrI
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February 10th, 2010 @ 2:40 am
oh heck yes
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February 10th, 2010 @ 2:40 am
@yungced yo check this lololol thats crazy http://www.youtube.com/watch?v=qtZliNN3VsA
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