Disease progression, adherence, and response to protease inhibitor therapy for HIV infection in an Urban Veterans Affairs Medical Center

Kevin Maher, Nancy Klimas, M. A. Fletcher, V. Cohen, C. M. Maggio, J. Triplett, R. Valenzuela, G. Dickinson

Research output: Contribution to journalArticle

63 Scopus citations

Abstract

Indinavir therapy has demonstrated promise in the treatment of HIV-1 infection in clinical trials; however, its efficacy in a U.S. Veterans Affairs Medical Center, where access to therapy is generally unimpeded, is unknown. A review of the Miami cohort was conducted for the year beginning May 1996 to 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 offered indinavir based on their having CD4 counts <200 cells/μl or viral loads >10,000 copies/ml. Of these patients, 36% were adherent and experienced significant reductions in viral loads (-93,325 ± 147,911 copies/ml) and elevations in CD4+ (111 ± 103 cells/μl) and CD8+ (225 ± 338 cells/μl) T cell counts. Adherent patients with baseline CD4 counts <100 cells/μl were 4.5 times more likely to have follow-up viral loads >10,000 copies/ml than those with CD4 >200 cells/μl. Adherent patients with CD4 counts <100 cells/μl did not show evidence of immune 'exhaustion' because they were equal to those with CD4 counts >200 cells/μl in their capacity to replenish CD4 cells. Nonadherence to the regimen resulted in loss of therapeutic benefit and suggested that strategies to enhance adherence may become an essential component of treatment.

Original languageEnglish (US)
Pages (from-to)358-363
Number of pages6
JournalJournal of Acquired Immune Deficiency Syndromes and Human Retrovirology
Volume22
Issue number4
StatePublished - Dec 1 1999

Keywords

  • Adherence
  • CD4
  • Human
  • Immune reconstitution
  • Indinavir
  • Lymphocyte
  • Protease inhibitor
  • Viral load

ASJC Scopus subject areas

  • Immunology and Allergy
  • Immunology
  • Virology

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