Pillboxes Help HIV-Positive Stick to Drug Regimens

NEW YORK - HIV-positive patients who use pillbox organizers to help keep track of their medications can reduce their risk of progressing to AIDS, a new study shows.

"Pillbox organizers should be a standard intervention to improve adherence to antiretroviral therapy," Dr. David R. Bangsberg of San Francisco General Hospital and colleagues conclude in their report, which is published in Clinical Infectious Diseases.

People with HIV infection who don't fully adhere to prescribed regimens run a greater risk of developing drug resistance, progressing to AIDS and dying, Bangsberg and his team point.

Pillbox organizers are the cheapest and most commonly used strategy to help people adhere to drug therapy, they add, but no studies have been done on whether these devices can help people with HIV to take their medications as prescribed.

To investigate, the researchers followed 245 HIV-infected men and women from 1996 through 2000, periodically checking their adherence to their antiretroviral regimens by conducting unannounced pill counts every three to six weeks. All study participants were taking at least three different medications.

Because it would have been unethical to randomly assign some patients to use a pill organizer but not others, the researchers used statistical techniques to compare adherence for individuals who chose to use pillbox organizers and those who did not. Sixty-one percent of the study participants used the organizers for at least one month during the course of the study.

Based on three different statistical models, the researchers found that pillbox users increased their adherence to prescribed drug regimens by up to 4.5 percent. They also had significantly lower level of HIV in their blood and were nearly twice as likely to have a viral load of 400 copies per milliliter or less. Pillbox users were also 11 percent less likely than non-users to progress to AIDS during the course of the study.

Antiretroviral regimens for HIV infection are simpler now than when the study was conducted, the researchers note, so it is unclear whether pillbox organizers would be equally helpful for patients today. Nevertheless, they add, "given the simplicity and low cost of the intervention, clinicians should consider including pillbox organizers in their routine treatment of chronic disease."

SOURCE: Clinical Infectious Diseases, October 1, 2007