Public health puts twist on AIDS regimens

Directly observed therapy may help Baltimore's HIV-infected patients follow a complex treatment regimen. But there are logistical hurdles.

By Susan J. Landers, AMNews staff. Feb. 25, 2002.

The ominous growth of drug-resistant AIDS viruses has led the city of Baltimore to try an approach that worked 35 years ago to combat tuberculosis -- directly observed therapy.

The city of approximately 650,000 now stands seventh or eighth in the nation as far as the prevalence of AIDS infection goes and the city health department, as well as the University of Maryland Institute of Human Virology, based in Baltimore, would like to check its spread.

The city and the institute are about to embark on separate projects to determine just how feasible it is to monitor closely individuals with HIV infection to make sure they unfailingly take their medications.

City health officials plan to experiment with applying directly observed therapy, a technique first successfully tried in Baltimore in the 1970s to help control TB, to improve treatment compliance for HIV infections, says the city's health commissioner, Peter Beilenson, MD.

Some observers question the likelihood of success. Medications to halt the AIDS virus are generally taken two or three times every day, making the logistics of the plan difficult. When applied to the substance abusing population, the odds of its working look even worse.

"I think in principle it is a great idea. All of the concerns are mostly logistical ones," said Joel Gallant, MD, MPH, associate professor of medicine at Johns Hopkins University.

Research bears this out. The approach has been used most successfully in prisons and methadone clinics.

But despite the difficulties in monitoring the medications of individuals who have the freedom to turn their backs on therapy, Robert Redfield, MD, director of clinical care and research at the Institute of Human Virology, believes the method must be given a fair trial. [...]