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All About Adherence

Carmen B. has been on and off HIV medications and has moved in and out of care several times. Her adherence to most of her regimens has been intermittent. In August 2000, she was lost to follow-up again. She reappeared in October 2000, stating that she had a new social worker, new support groups, a new therapist, and was in a much better life-situation; she convincingly argued that she was prepared to restart antiretrovirals. Her viral load was 92,500 copies/ml and her CD4 count was 138 cells/mm³ (17%). She started AZT + 3TC + ritonavir + indinavir. Two weeks after beginning her new regimen, she appeared happy and noted 100% adherence and no side effects. An indinavir level, drawn 2 hours after her last reported dose, returned at less than 0.025 µg/ml, below the limits of detection.