How Much Adherence Is Required?

How Much Adherence Is Required?

K Abriola from Hartford Hospital in Connecticut reported results from a prospective, observational 3-month analysis of adherence among a minority/IVDU inner-city population: 40 subjects (110 subject months), 30 male/10 female; 75% Hispanic/23% African-American; 68% IVDU; 68% on triple therapy. At baseline, 38% had CD4 count < 200 cells/ml; 23% CD4 count > 500 cells/ml; 27% viral load < 400 copies/ml; 35% viral load > 10,000 copies/ml. At 3 months, adherence by MEMS caps was significantly associated with virologic success with lower viral loads associated with >80% adherence (p < 0.05). Complete viral suppression was significantly associated with >90% adherence: 100% of subjects (n = 6/6 subj-months) with >90% adherence had complete viral suppression compared to 73% (n = 11/15) at 80-90% adherence, 48% (n = 12/25) at 70-80% and 23% (n = 15/64) at < 70%, p > 0.01. No correlation was observed between patient self-report and adherence by MEMS. Pill counts overestimated adherence (79.8% vs. 53.5%, p < 0.01). Females had significantly lower adherence than males (39.3% vs. 59.1%, p = 0.036).