***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: Background While the relationship between average adherence to  HIV potent antiretroviral therapy  is well defined , the relationship between patterns of adherence within adherence strata has not been investigated . We examined medication event monitoring system ( MEMS ) defined adherence patterns and their relation to subsequent virologic rebound . Methods and Results We selected subjects with at least 3-months of previous virologic suppression on a non-nucleoside reverse transcriptase inhibitor (NNRTI)-based regimen from two prospect i ve cohorts in France and North America . We assessed the risk of virologic rebound , defined as HIV RNA of > 400 copies/mL according to several MEMS adherence measurements . Seventy two subjects were studied , five of them experienced virologic rebound . Subjects with and without virologic rebound had similar baseline characteristics including treatment duration s , regimen ( efavirenz vs nevirapine ) , and dosing schedule . Each 10 % increase in average adherence decreased the risk of virologic rebound ( OR = 0.56 ; 95 % confidence interval ( CI ) [ 0.37 , 0.81 ] , P<0.002 ) . Each additional consecutive day off therapy for the longest treatment interruption ( OR = 1.34 ; 95%CI [ 1.15 , 1.68 ] , P<0.0001 ) and each additional treatment interruption for more than 2 days ( OR = 1.38 ; 95%CI [ 1.13 , 1.77 ] , P<0.002 ) increased the risk of virologic rebound . In those with low-to-moderate adherence ( i.e. < 80 % ) , treatment interruption duration ( 16.2 days versus 6.1 days in the control group , P<0.02 ) , but not average adherence ( 53.1 % vs 55.9 % , respectively , P = 0.65 ) was significantly associated with virologic rebound . Conclusions Sustained treatment interruption may pose a greater risk of virologic rebound on NNRTI therapy than the same number of interspersed missed doses at low-to-moderate adherence BACKGROUND Methadone clinic-based directly observed antiretroviral therapy ( DOT ) has been shown to be more efficacious for improving adherence and suppressing human immunodeficiency virus ( HIV ) load than antiretroviral self-administration . We sought to determine whether the beneficial effects of DOT remain after DOT is discontinued . METHODS We conducted a post-trial cohort study of 65 HIV-infected opioid-dependent adults who had completed a 24-week r and omized controlled trial of methadone clinic-based DOT versus treatment as usual ( TAU ) .  For 12 months after DOT discontinuation , we assessed  antiretroviral adherence using monthly pill counts and electronic monitors . We also assessed viral load at 3 , 6 , and 12 months after DOT ended . We examined differences between DOT and TAU in ( 1 ) adherence , ( 2 ) viral load , and ( 3 ) proportion of participants with viral load of < 75 copies/mL. RESULTS At trial end , adherence was higher among DOT participants than among TAU participants ( 86 % and 54 % , respectively ; P < .001 ) , and more DOT participants than TAU participants had viral loads of < 75 copies/mL ( 71 % and 44 % , respectively ; P = .03 ) . However , after DOT ended , differences in adherence diminished by 1 month ( 55 % for DOT vs 48 % for TAU ; P = .33 ) and extinguished completely by 3 months ( 49 % for DOT vs 50 % for TAU ; P = .94 ) . Differences in viral load between DOT and TAU disappeared by 3 months after the intervention , and the proportion of DOT participants with undetectable viral load decreased steadily after DOT was stopped until there was no difference ( 36 % for DOT and 34 % for TAU ; P = .92 ) . CONCLUSIONS Because the benefits of DOT for adherence and viral load among HIV-infected methadone patients cease after DOT is stopped , methadone-based DOT should be considered a long-term intervention AIMS AND OBJECTIVES This study aim ed to examine the effects of nurse-delivered home visits combined with telephone intervention on medication adherence , and quality of life in HIV-infected heroin users . BACKGROUND Drug use is consistently reported as a risk factor for medication non-adherence in HIV-infected people . DESIGN An experimental , pretests and post-tests , design was used : baseline and at eight months . METHODS A sample of 116 participants was recruited from three antiretroviral treatment sites , and 98 participants completed the study . They were r and omly assigned to two groups : 58 in the experimental group and 58 in the control group . The experimental group received nurse-delivered home visits combined with telephone intervention over eight months , while the control group only received routine care . The question naire of Community Programs for Clinical Research on AIDS ( CPCRA ) Antiretroviral Medication Self-Report was used to assess levels of adherence , while quality of life and depression were evaluated using Chinese versions of World Health Organization Quality of Life Instrument-Abbreviated version ( WHOQOL-BREF ) and Self-rating Depression Scale , respectively . Data were obtained at baseline and eight months . RESULTS At the end of eight months , participants in the experimental group were more likely to report taking 100 % of pills ( Fisher 's exact = 14.3 , p = 0.0001 ) and taking pills on time ( Fisher 's exact = 18.64 , p = 0.0001 ) than those in the control group . There were significant effects of intervention in physical ( F = 10.47 , p = 0.002 ) , psychological ( F = 9.41 , p = 0.003 ) , social ( F = 4.09 , p = 0.046 ) and environmental ( F = 4.80 , p = 0.031 ) domains of WHOQOL and depression ( F = 5.58 , p = 0.02 ) . CONCLUSIONS Home visits and telephone calls are effective in promoting adherence to antiretroviral treatment and in improving the participants ' quality of life and depressive symptoms  in HIV-infected heroin users . RELEVANCE TO CLINICAL PRACTICE It is important for nurses to recognise the issues of non-adherence to antiretroviral treatment in heroin users . Besides st and ard care , nurses should consider conducting home visits and telephone calls to ensure better health outcome of antiretroviral treatment in this population Background : There is a lack of effective behavioral interventions for HIV-positive injection drug users ( IDUs ) . We sought to evaluate the efficacy of an intervention to reduce sexual and injection transmission risk behaviors and to increase utilization of medical care and adherence to HIV medications among this population . Methods : HIV-positive IDUs ( n = 966 ) recruited in 4 US cities were r and omly assigned to a 10-session peer mentoring intervention or to an 8-session video discussion intervention ( control condition ) . Participants completed audio computer-assisted self-interviews and had their blood drawn to measure CD4 cell count and viral load at baseline and at 3-month ( no blood ) , 6-month , and 12-month follow-ups . Results : Overall retention rates for r and omized participants were 87 % , 83 % , and 85 % at 3 , 6 , and 12 months , respectively . Participants in both conditions reported significant reductions from baseline in injection and sexual transmission risk behaviors , but there were no significant differences between conditions . Participants in both conditions reported no change in medical care and adherence , and there were no significant differences between conditions . Conclusions : Both interventions led to decreases in risk behaviors but no changes in medical outcomes . The characteristics of the trial that may have contributed to these results are examined , and directions for future research are identified Background : Having opioid dependence and HIV infection are associated with poor  HIV-related treatment outcomes . Methods : HIV-infected , opioid-dependent subjects ( N = 295 ) recruited from 10 clinical sites initiated  buprenorphine/naloxone ( BUP/NX )  and were assessed at baseline and quarterly for 12 months . Primary outcomes included receiving antiretroviral therapy ( ART ) , HIV-1 RNA suppression , and mean changes in CD4 lymphocyte count . Analyses were stratified for the 119 subjects not on ART at baseline . Generalized estimating equations were deployed to examine time-dependent correlates for each outcome . Results : At baseline , subjects on ART ( N = 176 ) were more likely than those not on ART ( N = 119 ) to be older , heterosexual , have lower alcohol addiction severity scores , and lower HIV-1 RNA levels ; they were less likely to be homeless and report sexual risk behaviors . Subjects initiating BUP/NX ( N = 295 ) were significantly more likely to initiate or remain on ART and improve CD4 counts over time compared with baseline ; however , these improvements were not significantly improved by longer retention on BUP/NX . Retention on BUP/NX for three or more quarters was , however , significantly associated with increased likelihood of initiating ART ( β = 1.34 [ 1.18 , 1.53 ] ) and achieve viral suppression ( β = 1.25 [ 1.10 , 1.42 ] ) for the 64 of 119 ( 54 % ) subjects not on ART at baseline compared with the 55 subjects not retained on BUP/NX . In longitudinal analyses , being on ART was positively associated with increasing time of observation from baseline and higher mental health quality of life scores ( β = 1.25 [ 1.06 , 1.46 ] ) and negatively associated with being homo- or bisexual ( β = 0.55 [ 0.35 , 0.97 ] ) , homeless ( β = 0.58 [ 0.34 , 0.98 ] ) , and increasing levels of alcohol addiction severity ( β = 0.17 [ 0.03 , 0.88 ] ) . The strongest correlate of achieving viral suppression was being on ART ( β = 10.27 [ 5.79 , 18.23 ] ) . Female gender ( β = 1.91 [ 1.07 , 3.41 ] ) , Hispanic ethnicity ( β = 2.82 [ 1.44 , 5.49 ] ) , and increased general health quality of life ( β = 1.02 [ 1.00,1.04 ] ) were also independently correlated with viral suppression . Improvements in CD4 lymphocyte count were significantly associated with being on ART and increased over time . Conclusions : Initiating BUP/NX in HIV clinical care setting s is feasible and correlated with initiation of ART and improved CD4 lymphocyte counts . Longer retention on BPN/NX was not associated with improved prescription of ART , viral suppression , or CD4 lymphocyte counts for the overall sample in which the majority was already prescribed ART at baseline . Among those retained on BUP/NX , HIV treatment outcomes did not worsen and were sustained . Increasing time on BUP/NX , however , was especially important for improving HIV treatment outcomes for those not on ART at baseline , the group at highest risk for clinical deterioration . Retaining subjects on BUP/NX is an important goal for sustaining HIV treatment outcomes for those on ART and improving them for those who are not . Comorbid substance use disorders ( especially alcohol ) , mental health problems , and quality -of-life indicators independently contributed to HIV treatment outcomes among HIV-infected persons with opioid dependence , suggesting the need for multidisciplinary treatment strategies for this population OBJECTIVE The objective of this study was to systematic ally characterize the incidence and determinants of antiretroviral resistance in the HOMER ( Highly Active Antiretroviral Therapy [ HAART ] Observational Medical Evaluation and Research ) cohort of 1191 human immunodeficiency virus-infected , antiretroviral-naive adults initiating HAART in British Columbia , Canada . METHODS All plasma sample s with plasma virus loads ( pVLs ) > 1000 copies/mL collected during the first 30 months of follow-up were genotyped for drug resistance . The primary outcome measure was time to the first detection of major drug-resistance mutation(s ) . Cox proportional hazard regression was used to identify factors significantly associated with the detection of drug-resistance mutations . RESULTS Drug-resistance mutations were detected in 298 subjects ( 25 % ) . Factors significantly associated with detection of drug-resistance mutations included high baseline pVL ( multivariate hazard ratio [ HR ] , 1.59 ; P<.001 ) and adherence ( estimated using prescription-refill data and /or untimed plasma drug-concentration measurements ) . When compared with subjects with low ( 0%-<20 % ) prescription-refill percentages , subjects at an elevated risk of harboring drug-resistance mutations were those with relatively high but imperfect prescription-refill percentages ( 80%-<90 % ; multivariate HR , 4.15 ; P<.001 ) and those with essentially perfect 
    Output:
    
Cohort and prospect i ve studies suggested short-term increased cART adherence with MAT .
Of great concern was the virtual lack of interventions with sustained post-intervention adherence and virologic benefits .