Goals of Directly Observed Therapy for HIV Differ From Those for TB -- HIV/AIDS INFO AND UPDATES

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Date Posted: 12:12:32 05/16/02 Thu
Author: Anonymous
Subject: Goals of Directly Observed Therapy for HIV Differ From Those for TB

Goals of Directly Observed Therapy for HIV Differ From Those for TB

Reuters Health Information 2002. � 2002 Reuters Ltd
Republication or redistribution of Reuters content, including by framing or similar means, is expressly prohibited without the prior written consent of Reuters. Reuters shall not be liable for any errors or delays in the content, or for any actions taken in reliance thereon. Reuters and the Reuters sphere logo are registered trademarks and trademarks of the Reuters group of companies around the world.
Introduction
NEW YORK (Reuters Health) Apr 19 - Directly observed therapy (DOT) improves treatment of HIV and AIDS, results of pilot programs suggest. However, experience with DOT for tuberculosis (TB), for which DOT was designed, cannot answer such questions as ideal candidacy, cost-effectiveness, appropriate duration, and ultimate goals of such a program for HIV-infected patients.

In an invited article that appears in the April 1st issue of Clinical Infectious Diseases, Dr. Jennifer Adelson Mitty and associates note that DOT makes some sense for HIV-infected patients, since poor adherence to treatment for both TB and HIV can lead to the development of drug resistance.

However, treatment for HIV must be administered more frequently than TB treatment and, unlike TB, HIV treatment can be expected to last a lifetime.

DOT for HIV has been successful in prison settings, reducing patients' plasma viral levels over that of control subjects. In programs that enrolled patients with a history of poor adherence to therapy, patients who were compliant with the programs exhibited decreased blood levels of HIV mRNA, and in one program, increased CD4 cell counts.

Dr. Mitty, from Miriam Hospital in Providence, Rhode Island, and colleagues recommend that when DOT programs are being considered, they should be flexible in terms of the frequency and location of visits, and that they maintain patient confidentiality. They urge that consideration be given to the goal of providing individuals with the skills they need to maintain independent adherence to therapy.

The authors conclude that while short-term DOT programs directed at "marginalized" populations can be successful, "a multitude of questions remain." Nonetheless, they believe that the DOT approach "could allow clinicians to consider prescribing highly active antiretroviral therapy to individuals who may otherwise be considered untreatable."

Clin Infect Dis 2002;34:984-990.

http://www.medscape.com/viewarticle/432265_print

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