April 2001

Monitoring system provides limited adherence data

BOSTON — Researchers at the Boston University School of Medicine have shown that the Medication Events Monitoring System is limited in providing detailed accurate information. The study, which recently appeared in AIDS and Behavior, showed that the complexity of the regimen, patient lifestyle factors and the use of adherence aids such as pill boxes prove to be obstacles in using the system as an adherence measurement tool.

The study assessed adherence of antiretroviral medications using the system’s caps, as well as by patient self reporting over a 2-week period.

The study noted that if the system is to be considered consummate technology, then changes in hardware and its use must be considered. Decreasing the size of the device would appeal to many patients, as would combining the device with diary measures to indicate what was done at each opening. Since pillbox use is the most compromising situation for use of the system, the study suggested that technology should be developed to put a computer chip in each compartment of a pillbox to record the date and time.

Accurate means of assessing adherence to antiretroviral medications is imperative, since HIV will mutate if medication is not taken according to schedule.

People with HIV having problems adhering to therapy

RESEARCH TRIANGLE PARK, N.C. — People with HIV are finding it difficult to comply with their drug regimens, according to results of a recent survey.

A total of 371 people with HIV responded to surveys distributed by questionnaire to 2,500 households that reported having a member with HIV, and over the Internet to another 2,602 people. All respondents were ensured confidentiality.

Sixty-two percent of 262 respondents who were taking antiretrovirals said it is somewhat or very difficult to adhere to their prescribed regimen. Sixty-seven percent cited pill burden as the major obstacle to compliance, followed by adverse effects (61%), food restrictions (55%), frequency of dosing (49%) and timetable for having to take pills (48%). One percent of respondents noted cost as an obstacle. Forty-three percent of respondents said their drug regimen interfered with their daily life; 30% said it interfered with their lifestyle, and 11% said it interfered with their job.

Other research shows that 80% of patients admit missing doses at certain times. In one study, approximately 40% said they missed a dose in the previous 3 days, explaining that they forgot, were feeling sick, didn’t have the drugs with them at the right time or were too busy.

Free database available for AIDS research

SAN LEANDRO, Calif. — MDL Information Systems Inc., recently launched a free database containing information on selected compounds found to be active in the National Cancer Institute’s AIDS antiviral screen.

The database makes the data on compounds capable of inhibiting HIV accessible to researchers who use the company’s Integrated Scientific Information System.

The database will allow researchers to view chemical structures, compound names, registry numbers and quantitative screening results. Researchers can search for compounds by structure and perform group decomposition to analyze the structure-activity relationships that contribute to effective AIDS drugs. The data and structures are stored in Oracle using the company’s Relational Chemical Gateway.

For more information, visit the company’s Web site, www.mdli.com/contact.

Monkeys do not develop AIDS despite high virus load

WASHINGTON, D.C. — African green monkeys do not develop simian AIDS, despite high levels of the simian immunodeficiency virus (SIV) in their blood, according to research in the Journal of Virology. The finding challenges commonly held beliefs about how the virus and its cousin, HIV, cause disease.

SIV and HIV have long been thought to cause disease by replicating at a rapid pace inside immune cells, eventually overtaxing the immune system and causing it to fail. This model is supported by evidence that progression to AIDS in people is measured by a decline in CD4 immune cells that is associated with high levels of the virus in the blood.

Although scientists have long known that African green monkeys can be infected with SIV and not develop AIDS, it was believed that this was due to effective immune system control of the virus. However, researchers found high levels of virus in the blood of infected monkeys in this study. They also found high levels of viral replication in the central nervous system, believed to be the primary cause of neurological wasting, without any symptoms in the monkeys.

HIV-1 immunogen may help during treatment interruptions

PALM SPRINGS, Calif. — Preliminary data from an open-label study suggest that treatment with HIV-1 immunogen (Remune, Immune Response Corp.) may help people with HIV maintain control of the virus during structured treatment interruptions of their highly active antiretroviral therapy (HAART) regimen. The data were recently reported at the University of California Los Angeles AIDS Symposium.

Researchers studied 8 chronically infected HIV patients who were initially treated with both HAART and HIV-1 immunogen. Treatment interruptions consisted of closely monitored 8-week cycles off therapy, followed by 8 weeks on HAART therapy when patients received HIV-1 immunogen once every 3 months as an intramuscular injection.

During the first period off HAART, HIV replication increased in all patients (mean viral load, 18,060 copies/ml). However, during the second period off HAART, 7 patients had viral replication <10,000 copies/ml (mean viral load, 6,785 copies/ml).