HIV THERAPY ADHERENCE AND VIRAL RESISTANCE IN DRUG USERS

Project: Research project

Project Details

Description

DESCRIPTION: Applicant's Abstract

The proposed 5 year project will quantify adherence with combination
antiretroviral therapy in a well established longitudinal cohort of
HIV-infected drug users in the Bronx, New York City, and will determine the
impact of differing levels of adherence on changes in HIV viral load and
development of antiviral resistance. Combined antiretroviral therapy can
profoundly inhibit viral replication and markedly delay disease progression,
but achieving this potential in clinical practice requires adherence to
complex medical regimens. Nonadherence may result not only in reduced
treatment efficacy, but also in the selection of drug-resistant HIV strains.
There is active debate about the circumstances under which combination
antirotroviral therapy should be available to drug users because of concerns
about poor adherence to disseminated multi-drug resistant HIV, but the true
extent of adherence with combination antiretroviral therapy among drug users
is not known.

The specific aims of the proposed research include: (1) determining tho
extent of adherence with combination antiretroviral therapy among drug
users; (2) examining the impact of differing patterns of adherence on HIV
disease outcomes, including viral load and antiretroviral drug resistance;
(3) investigating prospectively HIV- and medication-specific beliefs and
other psychosocial predictors of adherence; and (4) identifying
sociodemographic, cultural and clinical characteristics that influence
adherence.

The study design includes the use of state-of-the-art electronic medication
monitors and patient self report to assess medication-taking adherence in
175 known HIV-seropositive drug users recruited from 10-year old HERO cohort
at Montefiore Hospital. At monthly research visits, adherence data will be
downloaded from the electronic device and blood will be drawn for HIV viral
load quantification and drug resistance studies. Phenotypic and genotypic
drug resistance assays will be performed on all subjects who have clinically
meaningful increases in HIV viral load. Quantification of viral load and
generation of HIV isolates will be performed by Dr. H. Farzadegan (Johns
Hopkins University), and drug resistance assays by Dr. V. Prasad (Albert
Einstein College of Medicine). This prospective study design will allow
characterization of the exact relationship between adherence patterns, viral
load, and development of drug resistance.
StatusFinished
Effective start/end date5/1/983/31/04

Funding

  • NATIONAL INSTITUTE ON DRUG ABUSE

ASJC

  • Infectious Diseases
  • Electrical and Electronic Engineering

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