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IAS: Directly Observed Therapy Helps Marginalized HIV Patients Control the Virus By Ed Susman PARIS, FRANCE -- July 16, 2003 -- Delivering antiretroviral drugs to marginalized patients with HIV -- such as active injecting drug users or homeless people -- can be accomplished through directly observed therapy (DOT), researchers reported here on July 14th at the 2nd International AIDS Society Conference on HIV Pathogenesis and Treatment. Frederick Altice, MD, an associate professor of medicine at Yale University School of Medicine, in New Haven, Connecticut, United States, said that among 85 individuals enrolled in his program, 85% had previously used antiretroviral drugs, 35% were homeless, 49% had major depression, and 21% had severe alcoholism. Patients of the school's AIDS Program Outreach facilities were treated by staffers operating from a 36-foot-long mobile health clinic linked to a syringe-exchange program. "Despite obstacles, these patients [experienced] improved health outcomes while on directly observed therapy," said Dr. Altice. Thirty-nine percent of patients who received medication directly from outreach personnel achieved HIV viral loads below the level of test quantification compared with 20% of controls, who were allowed to self-administer their therapy. Although 52 patients were originally randomized to receive directly observed therapy, 10 of those patients refused assignment, claiming that their HIV was under control, and did not require further observation. In fact, noted Dr. Altice, those individuals did indeed have their virus under control, and tests at the end of the 12-month study showed that levels remained undetectable using the 400 copies/mL assay. "HIV-positive injecting drug users with baseline viral suppression do not need directly observed therapy, and such resource-consuming efforts should be reserved for those who might benefit most," he said. In this study, patients were randomized by demographics, severity of alcohol use, antiretroviral experience, viral load, and CD4+ cell characteristics. They were evaluated at baseline, and then after 1, 3, 6, 9, and 12 months. [Study title: Directly Observed Therapy (DOT) for HIV+ Drug Users (IDUS). Abstract 40] E-mail this page to a friend or colleague! To print, use this version