Suchergebnisse

7‐11 November 2010, Tenth International Congress on Drug Therapy in HIV Infection, Glasgow, UK

BackgroundThe significant decrease in mortality has resulted in a large number of individuals aged over 50 living with HIV infection. Additionally, the coexistence of certain pathologies suggests premature aging. In this scenario, the presence of aging‐associated symptoms in the physician‐patient dialogue is yet to be explored.MethodsCross‐sectional observational study to evaluate the presence of aging‐associated symptoms in the physician‐patient dialogue and to explore the possible differences between genders in a sample of 100 HIV‐1 infected subjects diagnosed at least 15 years ago. The survey assessed questions/comments made by the patient, questions/comments made by the physician and patients' interest in obtaining more information than was provided. Number of patients and percentages were given and compared using the w2 or Fisher exact test (as appropriate).ResultsParticipants were 60 men and 40 women, diagnosed with HIV infection a median (IQ) of 18 (15.7–21) years ago, who had a nadir CD4 and CD4 cell count at the study entry of 172 (95–272) and 543 (403–677), respectively. Eighty percent of the subjects had VL <25 copies and 42% were HCV/HIV co‐infected (31 subjects with low fibrosis stage). The infection route had been mainly intravenous drug use (37%) and MSM (32%). Men and women had similar demographic and clinical characteristics. Sixty‐two percent of the participants acknowledged asking their physicians about aging‐associated symptoms (58% men vs 66% women; p=0.50), 48% reported that their physicians had provided information without having been asked (48% men vs 55% women; p=0.51) and 75% confirmed that they would like to have more information about aging‐associated symptoms (22% men vs 80% women; p<0.001).ConclusionsAround half of the men and women interviewed had discussed aging‐associated symptoms with their physician. However, this seemed insufficient for four‐fifths of the women, who would have liked to have obtained more information about aging.

BackgroundHealth beliefs are an important factor in the maintenance of an adherent behaviour. However, specific interventions based on the modification of health beliefs to promote adherence have not been applied in naïve HIV‐infected subjects.MethodsProspective randomized 48‐week study to evaluate the efficacy of a psychoeducative intervention based on health beliefs to promote adherence in a sample of naïve HIV‐1‐infected men who started antiretroviral therapy. Participants were randomized to follow three intervention visits to promote adherence with the use of projective drawing techniques, Life‐steps and Motivational interview (Intervention Group; GI) or to continue with the routine care (Control Group; GC). Adherence was assessed through self‐report and drug plasma levels. Mann‐Whitney nonparametric test, w2 or Fisher exact test were used to compare variables.ResultsParticipants were 40 men with a median (IQ) age of 35.2 (30.2–44.8) years, CD4 cell count at the study entry of 316 (229–539) cells/mm3 and HIV‐RNA VL of 65.000 (22.500–250.000) copies. The infection route had been mainly MSM (90%). QD and BID ARV therapy was prescribed in 29 (72.5%) and 11 (27.5%) subjects. Seven patients (2 in GI; 5 in GC) were lost to follow‐up. At week 48, 100% of subjects in GI and 60% in GC had 100% adherence (p=0.01). In GC, 26% and 14% of subjects had ≥95% and <95% adherence, respectively. No differences were found in adherence regarding QD or BID therapy. All subjects except for 3 had VL <25 copies at week 48.ConclusionsHigh adherence was observed in the majority of this group of naïve HIV‐infected men who initiated their first antiretroviral therapy. However, all subjects following the intervention had 100% adherence after one year of follow‐up. A psychoeducative intervention based on the modification of health beliefs may be a useful strategy to promote adherence in naïve HIV‐infected patients.

Purpose of the studyATV/r or DRV/r plus TDF/FTC are recommended for first‐line therapy due at least in part to their clinical tolerability and scarce metabolic effects. We investigated whether both regimens might differ regarding plasma lipids, insulin resistance (HOMA‐IR), and estimated glomerular filtration rate (MDRD).MethodsMulticentre, randomized, clinical trial (ATADAR Study, NCT01274780). Primary end‐point: 24‐week change in total cholesterol. Secondary end‐points: changes in lipids other than total cholesterol, HOMA‐IR, and MDRD; clinical tolerability; and efficacy. We assumed that patients assigned to DRV/r would have an increase in plasma total cholesterol<21 mg/dL, which was the difference between lopinavir/r and ATV/r in CASTLE study. Fasting plasma lipids, glucose, insulin, and creatinine were measured at baseline, and 4, 12, and 24 weeks. Analyses were by intent‐to‐treat.Summary of results180 patients were randomized (ATV/r=91, DRV/r=89), 95% Caucasian, and 8% co‐infected with hepatitis C virus. At baseline (mean, SD): age 36 (9) years; plasma log HIV RNA 4.8 (0.7); CD4 334 (189) cells/mm3; triglycerides 107 (62), total cholesterol 158 (32), LDL cholesterol 97 (28), HDL cholesterol 39 (11) mg/dL, and glucose 84 (13) mg/dL; HOMA‐IR 2.47 (3.46); and MDRD 108 (21) mL/min/1.73 m2. At 24 weeks, total cholesterol (mean, SD) changed +7.26 (26.76) mg/dL with ATV/r and +11.47 (25.85) mg/dL with DRV/r (estimated difference ATV/r minus DRV/r −4.21 (95% CI−12.11 to +3.69), P=0.2944), thus confirming our primary hypothesis. Changes (mean, SD) in triglycerides were roughly similar: +16.29 (61.76) mg/dL with ATV/r and +18.40 (64.24) mg/dL with DRV/r (P=0.8261), but there were trends to more favourable changes in LDL (−2.14 [21.45] vs +3.14 [21.97] mg/dL, P=0.1160) and HDL cholesterol (+5.50 [10.36] vs +3.88 [8.42] mg/dL, P=0.2625), and total‐to‐HDL cholesterol ratio (−1.16 [6.38] vs −0.14 [0.86], P=0.0652) with ATV/r than with DRV/r. There were small, non‐significant decreases in HOMA‐IR (ATV/r −0.17 [2.48] vs DRV/r −0.70 [3.38], P=0.3785) and MDRD (ATV/r −7 [22] vs DRV/r −6 [15] mL/min/1.73 m2, P=0.6652). 6 ATV/r and 3 DRV/r patients had their study drugs discontinued because of adverse effects (P=0.4967). 7 additional patients in each arm had confirmed HIV RNA >50 copies.ConclusionsThere were trends to more favourable changes in LDL and HDL cholesterol and particularly total‐to‐HDL cholesterol ratio at 24 weeks with ATV/r than with DRV/r.