Predictors of Virologic Success in Patients Completing a Structured Antiretroviral Adherence Program

This study describes the effects of a structured, educational/motivational antiretroviral adherence program on virologic and immunologic parameters in HIV-infected patients. Patients were referred because of either self- or provider-identified barriers to adherence. All patients completed 6 to 8 weekly sessions with a nurse or adherence counselor, followed by four quarterly sessions. Sessions included an adherence assessment, individualized patient education, review of adherence strategies, motivational messages, anticipatory planning, and adherence tools. The 58 patients had a mean enrollment CD4 (+) count of 223 cells/mm (3) and mean viral load of 196,454 copies/ml. At the last follow-up, the mean CD4 (+) count increased to 308 cells/mm (3) (p <.001), and mean viral load decreased to 43,309 (p <.001). Thirty (51.7%) patients achieved a viral load < 50 copies/ml at any point during follow-up. Factors associated with final viral load < 50 copies/ml included not being a cigarette smoker, receiving lamivudine in one's final regimen, and having an HIV risk behavior other than male-male sex.