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Evaluating supervised haart in late-stage HIV among drug users: A preliminary report

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Abstract

Objective

To examine response to highly active antiretroviral therapy (HAART) among a sample of treatment-experienced patients in the late stage of human immunodeficiency virus (HIV) infection in residential health care facilities (RHCFs) in New York City facilities designated for HIV/AIDS (acquired immunodeficiency syndrome) when access and adherence are maximized.

Methods

Medical record review of 111 patients.

Results

Demographics were mean age 42 years; 58% male; 60% African-American; 31% Hispanic; 57% injection drug users (IDUs); 23% with history of dementia; 52% hepatitis C virus (HCV) antibody seropositive; 80% on HAART, of whom 18% had lipodystrophy. Of 88 patients on HAART, 52% had a decreased viral load (>1/2log) versus 13% of 23 not on HAART (P<.05); a>1/2log viral load increase was seen in 8% and 35%, respectively (P<.05). Those with viral load increase were more likely than those with stable/decreased viral load to be IDUs (71% vs. 64%) and to have HCV seropositivity (86% vs. 53%), even with similar initial CD4+ cell count, viral load, and follow-up time.

Conclusion

In a predominantly minority IDU population who are treatment experienced, 50% of the patients successfully responded to treatment with supervised therapy. The RHCFs in New York City provide a unique opportunity to examine further factors associated with response to HAART in an environment in which medication administration and adherence are maximized and monitored carefully.

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Authors and Affiliations

  1. Office of Special Populations/Center for Urban Epidemiologic Studies, New York Academy of Medicine, Room 443, 1216 Fifth Avenue, 10029, New York, NY

    Barbara Greenberg MSc, PhD,  Ruth Finkelstein ScD,  Jacquie Astemborski MHS &  David Vlahov PhD

  2. Bronx-Lebanon Special Care Center, Bronx-Lebanon, USA

    Alan Berkman MD &  Rogelio Thomas MD

  3. AIDS Institute, New York State Department of Health, New York, USA

    David Hoos MD

Authors
  1. Barbara Greenberg MSc, PhD
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  2. Alan Berkman MD
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  3. Rogelio Thomas MD
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  4. David Hoos MD
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  5. Ruth Finkelstein ScD
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  6. Jacquie Astemborski MHS
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  7. David Vlahov PhD
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Corresponding author

Correspondence to Barbara Greenberg MSc, PhD.

Additional information

Dr. Berkman is from Columbia University/Highbridge Woodycrest Residential Health Care Facility.

Ms. Astemborski is from the Johns Hopkins School of Hygiene and Public Health.

Supported by the New York Academy of Medicine.

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Greenberg, B., Berkman, A., Thomas, R. et al. Evaluating supervised haart in late-stage HIV among drug users: A preliminary report. J Urban Health 76, 468–480 (1999). https://doi.org/10.1007/BF02351504

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