How much does directly administered ART affect virological outcome?
Although directly administered ART (DAART) has been shown to be beneficial in HIV-infected drug users, a recent study found that the persistence of DAART after self-administered therapy (SAT) did not improve virological outcomes in this population.2 Maru and colleagues2 studied 141 HIV-infected drug users who received 6 months of DAART or SAT. Virological success was defined as either an HIV-1 RNA level of less than 400 copies/mL or a 1.0 log10 reduction from baseline. After 6 months of therapy, the 2 groups did not differ in virological success (58% in the DAART group and 56.7% in the SAT group). They also did not differ in mean reduction in log10 HIV-1 RNA level or mean change in CD4 count. A high level of social support was the only significant predictor of virological success. The authors say that this finding suggests the need for integrated interventions that address complicated social issues. Also, the provision of co-located medical and case management services may be a particu
