The Washington Blade; May 15, 1998
Lisa Keen

Asked what the "number one reason" why adherence to the drug therapy was so difficult, 22 percent cited the requirement of many drugs to be taken with or without food. Fourteen percent cited the complexity of their pill-taking regimens, and 13 percent said they were bothered by side effects. But 19 percent cited a wide variety of "other reasons," including concerns about privacy, the taste of the drugs, their costs, and difficulty in swallowing pills.

Adherence is considered a very serious requirement in order for the combination therapies to work because failure to maintain adherence can undermine the therapy's ability to keep the AIDS virus suppressed. But a triple drug regimen can require a patient to take 14 to 30 pills a day (plus whatever drugs are needed to prevent opportunistic infections) some with food, some without.

The study, which appears in this month's Journal of the International Association of Physicians in AIDS Care, was conducted by researchers at Johns Hopkins University and the DuPont Merck Pharmaceutical Company. Merck & Co., one of DuPont Merck's two partner companies and the maker of the protease inhibitor indinavir, is providing a package of materials entitled "Live It" to help patients adhere to its drug and others. The package (available in English and Spanish) includes stickers to put on "pill charts," food lists, and a "dosing wheel" to help patients figure when and how to take pills in conjunction with food.

In brief ...

AVOID STRESS AND CHANGE: It is, perhaps, just common sense, but researchers at the University of California-Davis reported in the Proceedings of the National Academy of Sciences April 14 that they have confirmed that emotional stress causes a worsening of HIV disease. Studying groups of monkeys with HIV, the doctors found that monkeys given "social time" with the same monkeys every day lived 40 percent longer than those given "social time" with a constantly changing group of monkeys.

AND AVOID 'ECSTASY': The AIDS advocacy group Project Inform in San Francisco warned users of the protease inhibitor ritonavir last month that, "based on computer modeling," the simultaneous use of ritonavir and the illegal recreational drug Ecstasy is "a poor idea." The ritonavir increases the level of Ecstasy in the bloodstream by three to five times, sometimes more, increasing the chances for a drug overdose.

LITTLE DECLINE IN HIV: Much ado was made in the mainstream media earlier this year about a decline in the number of people being reported with full-blown AIDS. As some observers suspected, those declines can not be translated into similar declines in the number of HIV infections. The April 24 Morbidity and Mortality Weekly Report from the U.S. Centers for Disease Control and Prevention provided data from 25 states that show that while the number of AIDS cases declined by 9 percent from 1995 to 1996, the HIV cases declined by only 2 percent. (The 25 states include Virginia and New Jersey, but not D.C., Maryland, and New York.) Thirty-two percent of the 52,690 reported HIV cases were attributed to men having sex with men; the second largest category (28 percent) was cases for which no means of transmission was reported.

ONE-IN-THREE BAREBACKING: A survey of 105 men who have sex with men, conducted primarily on the street in San Francisco's Castro district in March of this year, indicated that 37 percent have had unprotected anal sex during the previous six months. The survey, conducted by ACT UP/Golden Gate and published in the April 16 issue of the Bay Area Reporter newspaper, was also conducted in 1994. At that time, according to BAR, 24 percent reported engaging in unprotected anal sex, also known as barebacking.

ANOTHER PROTEASE PHENOMENON? French researchers reported last month, in the April 16 journal AIDS, that eight of 32 patients on the protease inhibitor indinavir have developed loss of fatty tissue in the face, resulting in sunken eyes and a "pronounced" wasting appearance. Oddly, the patients did not experience any weight loss. Indinavir and other protease inhibitors have been associated with another phenomenon involving the fatty tissue, where body fat has accumulated in the lower abdomen and at the base of the neck. Researchers have not yet associated any of these phenomena with health risks.

3TC AND THE NAILS: According to a report from Reuters, doctors in Italy reported seeing about a dozen cases of people with HIV on the antiviral nucleoside 3TC with a severe skin infection around their nails caused by Candida.

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