Resuppression of virus load after interruption in treatment with nevirapine and 2 nucleoside reverse-transcriptase inhibitors.

This retrospective chart review evaluated the effectiveness of reinitiation of treatment with nevirapine and dual nucleoside-analogue reverse-transcriptase inhibitors (NRTIs) after an interruption in antiretroviral therapy in 135 patients with human immunodeficiency virus type 1 RNA levels of <400 copies/mL who were receiving the same regimen. Reinitiation of a nevirapine regimen resulted in resuppression of virus load to <400 copies/mL in most patients who adhered to the regimen. Direct interruption of a non-NRTI regimen could lead to easier and more efficient structured protocols for treatment interruption.

Effectiveness and tolerability of nevirapine, stavudine, and lamivudine in clinical practice.

BACKGROUND: Recent studies reveal patients on protease inhibitor (PI)-based regimens achieve viral suppression less often in clinical practice than in clinical trials. Nonnucleoside reverse transcriptase inhibitors (NNRTIs) can provide an equally effective and more convenient alternative. PURPOSE: This retrospective chart review examines the effectiveness, tolerability, and convenience of a nevirapine (NVP), stavudine (d4T), and lamivudine (3TC)-containing regimen in an urban HIV clinical practice. METHOD: Chart review of patients from September 1996 to April 2000 yielded 73 patients on NVP+d4T+3TC; 83.6% were treatment experienced. RESULTS: By 16 weeks, 86.4% (57/66) had viral loads (VL) <400 in an as-treated (AT) analysis, while 78.1% (57/73) had VL <400 in an intent-to-treat (ITT) analysis. By 24 weeks, 84.6% (33/39) had VL <50 (AT). Beyond 48 weeks, 88.9% (16/18) had VL <50. The mean CD4 increase was 170 cells/mm(3). Rash was the most common adverse event (13.7%) in this review. CONCLUSION: Consistent with other studies, this NVP+d4T+3TC regimen appears effective in both treatment-experienced and -naive patients, regardless of baseline viral loads, in a clinical practice setting.

Problem drinking and medication adherence among persons with HIV infection.

OBJECTIVE: To examine the relation between problem drinking and medication adherence among persons with HIV infection. DESIGN: Cross-sectional survey. SETTING/PARTICIPANTS: Two hundred twelve persons with HIV infection who visited 2 outpatient clinics between December 1997 and February 1998. MEASUREMENTS AND MAIN RESULTS: Nineteen percent of subjects reported problem drinking during the previous month, 14% missed at least 1 dose of medication within the previous 24 hours, and 30% did not take their medications as scheduled during the previous week. Problem drinkers were slightly more likely to report a missed dose (17% vs 12 %, P =.38) and significantly more likely to report taking medicines off schedule (45% vs 26%, P =.02). Among drinking subtypes, taking medications off schedule was significantly associated with both heavy drinking (high quantity/frequency) (adjusted odds ratio [OR], 4.70; 95% confidence interval [95% CI], 1.49 to 14.84; P <.05) and hazardous drinking (adjusted OR, 2.64; 95% CI, 1.07 to 6.53; P <.05). Problem drinkers were more likely to report missing medications because of forgetting (48% vs 35%, P =.10), running out of medications (15% vs 8%, P =.16), and consuming alcohol or drugs (26 % vs 3 %, P <.001). CONCLUSION: Problem drinking is associated with decreased medication adherence, particularly with taking medications off schedule during the previous week. Clinicians should assess for alcohol problems, link alcohol use severity to potential adherence problems, and monitor outcomes in both alcohol consumption and medication adherence.