Adherence shows advantages over T-cell counts for monitoring HIV treatment
Information on how reliably people take their anti-HIV medicines can help identify those whose treatment will succeed or fail. Monitoring this information, which can be obtained directly from pharmacy records, works at least as well as performing blood tests that track the medicine’s effect on the immune system, according to research published in PLoS Medicine by Gregory Bisson, Jean Nachega and colleagues at the University of Pennsylvania, Johns Hopkins Bloomberg School of Public Health, and the University of Cape Town.
Adherence, or taking medications exactly as prescribed, has long been known to be a key factor in the success of HIV treatment. In developed countries, success has been defined using blood tests to measure how well medications suppress the AIDS virus. These so-called viral load tests are often difficult to provide in developing countries, so alternatives are used, including CD4 T-cell counts, which indicate how well the immune system is responding to treatment. However, falling CD4 counts tend to indicate treatment failure only after the fact, often at a point when the virus has developed resistance and the patient’s medications must be changed, typically to drugs that are more costly or difficult to take.
Working with an insurance plan that covers HIV treatment in 9 African countries, the researchers in this study calculated patient adherence from monthly claims for AIDS medicines actually dispensed by pharmacies, in proportion to the number of months that medicines were prescribed to the patient. Statistically comparing these adherence measures to CD4 test results in more than 1800 patients whose viral load results were available, they found that adherence was more accurate than CD4 counts in identifying individuals who went on to experience treatment failure over 6 months and 12 months of treatment.
These findings suggest that adherence assessments could be used for early identification of patients at high risk of treatment failure, averting its health impact and helping to prioritize limited viral load testing. Studies in other settings (such as public clinics where medication is provided without charge) are needed to confirm the general reliability of these findings.
These results do not change that fact that monitoring CD4 counts plays an important role in deciding when to begin HIV medications, or when to provide treatment to prevent conditions that occur at low CD4 counts. Nonetheless, according to the researchers, approaches to HIV treatment in resource-limited settings should include an adherence-based monitoring approach.
In an accompanying perspective article, David Bangsberg (University of California San Francisco, USA), who did not participate in the research, discusses the importance of proactive prevention rather than reactive response to HIV treatment failure.
Citation:Bisson GP, Gross R, Bellamy S, Chittams J, Hislop M, et al. (2008) Pharmacy refill adherence compared with CD4 count changes for monitoring HIV-infected adults on
antiretroviral therapy. PLoS Med 5(5): e109. doi:10.1371/journal.pmed.0050109
IN YOUR COVERAGE PLEASE LINK TO THIS URL, WHICH WILL PROVIDE ACCESS TO THE PUBLISHED PAPER: http://medicine.plosjournals.org/perlserv/?request=get-document&doi=10.1371/journal.pmed.0050109
PRESS-ONLY PREVIEW OF THE ARTICLE: http://www.plos.org/press/plme-05-05-bisson.pdf
CONTACTS:
Gregory P. Bisson
University of Pennsylvania School of Medicine
Center for Clinical Epidemiology and Biostatistics
Philadelphia, PA 19104-6021
United States of America
+1 215 573-5811
+1 215 573-5315
bisson@mail.med.upenn.edu
Related PLoS Medicine Perspective article:
Citation: Bangsberg DR (2008) A paradigm shift to prevent HIV drug resistance. PLoS Med 5(5): e11.doi:10.1371/journal.pmed.005011
IN YOUR COVERAGE PLEASE LINK TO THIS URL, WHICH WILL PROVIDE ACCESS TO THE PUBLISHED PAPER: http://medicine.plosjournals.org/perlserv/?request=get-document&doi=10.1371/journal.pmed.0050111
PRESS-ONLY PREVIEW OF THE ARTICLE: http://www.plos.org/press/plme-05-05-bangsberg.pdf
CONTACT:
David Bangsberg
University of California San Francisco
San Francisco General Hospital
Division of Infectious Diseases and the Positive Health Program
San Francisco, CA 92037
United States of America
+1 415-206-3462
db@epi-center.ucsf.edu
Role for vegf messenger RNA in promoting malignancy of human colon cancer cells
Vascular endothelial growth factor-A (VEGF) is a key regulator of tumor development, and a therapeutic target for cancer treatment. However, clinical trials have suggested that anti-VEGF monotherapy is less effective than standard chemotherapy. Shigetada Teshima-Kondo and colleagues from the Institute of Health Bioscience, Tokushima, Japan investigated the role of vegf messenger (m)RNA in a line of cells from a colonic cancer. They showed that these cancer cells have a survival system that is regulated by vegf mRNA and hence that vegf mRNA and its protein may work together to promote the malignancy of tumor cells. Further work will need to be done to investigate how generalizable these findings are. The findings are discussed further in a Perspective article by Thomas Hughes and Pamela Jones, independent experts at the University of Leeds, UK, who were not involved in the study.
Citation: Masuda K, Teshima-Kondo S, Mukaijo M, Yamagishi N, Nishikawa Y, et al. (2008) A novel tumor-promoting function residing in the 59 non-coding region of vascular endothelial growth factor mRNA. PLoS Med 5(5): e94. doi:10.1371/journal.pmed.0050094
IN YOUR COVERAGE PLEASE LINK TO THIS URL, WHICH WILL PROVIDE ACCESS TO THE PUBLISHED PAPER: http://medicine.plosjournals.org/perlserv/?request=get-document&doi=10.1371/journal.pmed.0050094
PRESS-ONLY PREVIEW OF THE ARTICLE: http://www.plos.org/press/plme-05-05-teshima-kondo.pdf
CONTACT:
Shigetada Teshima-Kondo
University of Tokushima Graduate School
Institute of Health Bioscience
Department of Stress Science
3-18-15 Kuramoto-cho
Tokushima 770-8503
Japan
+81-88-633-9008
+81-88-633-9008 (fax)
kondoshi@basic.med.tokushima-u.ac.jp
Related PLoS Medicine Perspective article:
Citation: Hughes TA, Jones PF (2008) Regulatory RNAs: Have mRNA untranslated regions joined the party? PLoS Med 5(5): e110. doi:10.1371/journal.pmed.0050110
IN YOUR COVERAGE PLEASE LINK TO THIS URL, WHICH WILL PROVIDE ACCESS TO THE PUBLISHED PAPER: http://medicine.plosjournals.org/perlserv/?request=get-document&doi=10.1371/journal.pmed.0050110
PRESS-ONLY PREVIEW OF THE ARTICLE: http://www.plos.org/press/plme-05-05-hughes.pdf
CONTACT:
Thomas Hughes
University of Leeds
Leeds Institute of Molecular Medicine
Section of Molecular Gastroenterology
St. James's University Hospital
Leeds, LS9 7TF
United Kingdom
+44 113 3438624
+44 113 3438431 (fax)
t.hughes@leeds.ac.uk
Journal
PLoS Medicine