Sometimes the simplest things can make a dramatic difference in medicine. Johns Hopkins researchers report that a portable device that's "a cross between a pager and your own mother" can, within half a year, lead to a significant drop in the amount of virus HIV patients carry in their blood or spinal fluid. The device is not a new therapy: It's an electronic gadget that verbally reminds patients burdened with a complex schedule of anti-AIDS medications when to take pills and what side effects to watch out for. Taking the right dose of the right pills at the right time — adherence — is a major problem in a disease where patients may take dozens of medications a week, the researchers say.
The pocket-size device — which Hopkins researchers call DMAS, for Disease Management Assistance System, and the inventor has named "Jerry the Pharmacist" — has proved especially helpful for a subgroup of study patients with mild-to-moderate memory problems brought on by the disease. "These patients have the greatest difficulty holding to a therapy schedule which ordinarily could keep the disease at bay," says lead researcher Justin C. McArthur, M.D. "Now we see that a little electronic help can substantially improve compliance."
The scientists presented early study results at last month's Conference on Retrovirus and Opportunistic Infections held in Chicago.
Of the 19 subjects out of a targeted 86 who've completed the half-year trial, those on DMAS stuck with their therapy, on average, 11 percent more often than those who heard a monthly half-hour pep talk on how and why to use their medications. Many of the DMAS patients had compliance ratings of 90 percent or higher, confirmed by a backup system using microchip-containing pill bottles that self-report when they're opened.
The DMAS patients, all on a complex regimen of at least three anti-HIV drugs, also experienced an average 10-fold drop in viral presence in their blood or spinal fluid when compared with control patients. "This is an impressive decline for such a relatively simple technique," says researcher Adriana Andrade, M.D. In addition, measures of CD4 cells, the immune cells the virus most readily targets, increased by 50 cells/milliliter of blood in patients with the device, but by a fifth of that in those without it.
DMAS operates like a "cross between a pager and someone's mother," says Andrade. When it's time for medicine, the device beeps and a light flashes. Patients press a "play" button and a voice instructs them to take a particular drug. Patients push a second button when they've taken the medicine. Forget any of these steps and DMAS continues to beep periodically for several hours.
The system's software also adds messages about possible side effects or how to offset them. With specific AIDS drugs, for example, patients hear: "If you experience tingling in your hands or feet, call your doctor" or "Try to drink eight glasses of water a day with this medication."
Then, at the next clinic visit, staff download the compliance information, which appears as a written printout for doctor and patient to discuss. "Most who use this system say they find it extremely helpful," says Andrade; "It adds some structure to their therapy; something that frees them to focus on other things."
In a second Hopkins study, neurology researcher Henraya Davis, Ph.D., programmed the device to occasionally ask patients to press the "play" key at short intervals. The speed of response allows physicians to see if patients' reaction time is slowing as the disease progresses and gives a quick check on HIV's spread into the brain.
