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December 25, 1996

Should Directly Observed Therapy Be Considered for Treatment of HIV?

Author Affiliations

Saint Joseph Medical Center Reading, Pa

JAMA. 1996;276(24):1956. doi:10.1001/jama.1996.03540240034025

To the Editor.  —Directly observed therapy (DOT) for tuberculosis (TB) treatment counteracts noncompliance, a major factor in the emergence of multidrug-resistant TB (MDR TB).1 Although TB resistance has been recognized as a threat to public health, important similarities may apply to human immunodeficiency virus (HIV) infection. For instance, in pretreated patients, naturally occurring resistant TB1 and HIV2 have been described. Moreover, the medical logic for anti-TB treatment is analogous to that for treatment with anti-HIV medications: the drug regimen must be delivered reliably to prevent selecting for multidrug resistance and, for HIV, to prevent development of mutant viral strains.Combination antiretroviral therapy can reduce HIV viral load to undetectable levels in 80% of patients3 and reduce mortality and morbidity.4 However, patient compliance is key to antiretroviral success; the most powerful combinations will be of no benefit if taken erratically. In addition, noncompliance may lead to the