Improving Medication Adherence in HIV

Since the introduction of antiretroviral therapy more than a decade ago, morbidity and mortality among patients infected with HIV has decreased considerably thanks to improved access to care, prophylaxis against opportunistic infections, and medications. In the September 1, 2009 issue of Clinical Infectious Diseases, guidelines were released to assist clinicians managing this infection. They provide information on patient management as well as medication adherence, and can assist clinicians in all stages of HIV management. Judith A. Aberg, MD, who was on the guideline panel that was created by the HIV Medicine Association of the Infectious Diseases Society of America, says “once therapy has been initiated, the response to therapy should be monitored 4 to 8 weeks later with a repeated virus load determination.” CD4 cell counts should be followed both for assessment of antiretroviral efficacy and to determine the need for prophylaxis against opportunistic infections. A Multipronged Approach to Adherence In the December 8, 2009 Journal of the American College of Cardiology, my colleagues and I conducted a study in which we compared outcomes in 2,868 patients who underwent PCI for ACS just prior to enrollment in the PROVE IT–TIMI 22 (Pravastatin or Atorvastatin Evaluation and Infection Therapy–Thrombolysis In Myocardial Infarction 22) trial. The PROVE IT–TIMI 22 randomized ACS patients to either 80 mg atorvastatin or 40 mg pravastatin daily. Of the original cohort, 69% had undergone PCI just prior to randomization. The incidence of the primary composite end point of all-cause mortality, myocardial infarction, unstable angina leading to hospitalization, and revascularization after 30 days and stroke was evaluated. We also assessed the incidence of TVR and non-TVR during...