A Friendly Reminder For HIV Patients

The investigators report that the device, dubbed "Jerry" by mostusers, is a portable gadget programmed to ease the task of takingmedicines in multiple doses every day on time. HIV-infected patients,particularly those suffering from mild memory loss from the disease,benefit highly from Jerry's friendly reminders, according to a studypublished in the Sept. 15 issue of the journal Clinical InfectiousDiseases.

Like an alarm clock, Jerry, more properly known as DiseaseManagement Assistance System (DMAS), flashes a light and verbally tellsthe patient the exact dosage and medication to take at the correcttime. DMAS is rechargeable and weighs about as much as a cell phone.Its computer programming keeps track of the patient's compliance,allowing the doctor to download and print a report for monitoring thepatient's adherence to the medication schedule.

"One of the biggest reasons HIV patients cite for not takingtheir medication is just plain forgetfulness," says Adriana Andrade,M.D., M.P.H., assistant professor at the Johns Hopkins UniversityDivision of Infectious Diseases. "We thought a verbal reminder would bethe best possible solution."

According to Andrade, treating HIV can be a grueling task forpatients who must follow a hectic pill schedule, a combination of drugscalled highly active antiretroviral therapy (HAART). Those who misstheir medication a few times quickly develop a viral resistance to thedrug, a problem since replacement options are few.

"On average, HIV-infected, treatment-naïve patients today takeroughly two pills once a day, a significant decrease from a few yearsago, when patients had to juggle dozens of medications per week," saysAndrade. "But with all the regimens, patients must adhere to theirmedication faithfully because the virus easily develops a resistance,more so than most infectious diseases."

HIV can cause brain damage, making it more difficult for somepatients to remember their HAART regimen, which is often different forevery patient.

"We recruited patients with either normal memory or mild memoryimpairment for the study," says Andrade. "The results indicate thatboth groups adhered to their medication more so than not with Jerry,but the memory-impaired patients showed a greater improvement."

Fifty-eight of 64 patients completed the four-month study. Halfof the patients were given a Jerry device and attended adherencecounseling sessions, while the other half received only counseling.Those with Jerry took their medication 80 percent of the time, whilethose without did so only 65 percent of the time.

Of the 31 memory-impaired patients, those using Jerry had a 77percent adherence rate, while those without Jerry had a 57 percentadherence rate, a 20 percent difference. The remaining patients withnormal memory also adhered more with Jerry, but there was not asignificant variance from those without the device, according to theresearchers.

Throughout the study, all patients were given plasma viral loadtests, which measure the amount of HIV in the blood. However, there wasno significant difference in lessening the HIV amount between thosewith or without Jerry, according to the researchers.

"Hopefully, other devices like the DMAS will be furtherevaluated in similar studies, while incorporating the recenttechnologies of the two-way pager, cell phones or special alarmclocks," says Andrade.

The DMAS used in this study was manufactured by Adherence Technologies.

Funding was provided by grants from the National Institutes ofHealth, the Johns Hopkins Hospital General Clinical Research Center andMerck Laboratories.

Other researchers involved in the study were Henraya McGruder,Ph.D.; Albert Wu, M.D., M.P.H.; Shivaun Celano, Pharm.D.; RichardSkolasky Jr., M.A.; Ola Selnes, Ph.D.; I-Chan Huang, Ph.D.; and JustinMcArthur, M.B.B.S., M.P.H.

On the web:http://www.journals.uchicago.edu/CID/journal/rapid.html