title: Macrocytosis as an indicator of medication (zidovudine) adherence in patients with HIV infection.
abstract: This retrospective chart review was conducted in an outpatient human immunodeficiency virus (HIV) clinic to determine if macrocytosis can be used as a clinical indicator of zidovudine adherence in HIV-infected outpatients. This study included 71 HIV-positive patients who were taking zidovudine and 93 HIV-positive controls who were not taking zidovudine, for 8 weeks or longer. One control and 16 subjects were excluded secondary to insufficient laboratory data or preexistence of other macrocytosis-inducing etiologies. The incidence of macrocytosis (mean corpuscular volume [MCV] >/= 100 fL) was significantly different among subjects and controls: 78% versus 32.6% (p < 0.001), respectively. Adherence (determined by documentation from a physician/pharmacist) was assessed among subjects for whom zidovudine was prescribed, comparing those with and without macrocytosis. Adherence was observed in 77% and 18% of the macrocytosis-positive and macrocytosis-negative subjects, respectively (p < 0.001). Macrocytosis was also observed in patients receiving stavudine (another thymidine analogue, in the class of nucleoside reverse transcriptase inhibitors). Twenty-seven of the 41 patients for whom stavudine was prescribed developed macrocytosis (65.8%). These results indicate that macrocytosis may be useful in assessing adherence to zidovudine-containing antiretroviral regimens and may also have a role in assessing stavudine adherence.
authors.affiliation: University of Kentucky College of Pharmacy, Lexington, Kentucky 40536, USA. froma2@uky.edu
authors.forename: Frank
authors.initials: F
authors.lastname: Romanelli
authors.forename: Kerry
authors.initials: K
authors.lastname: Empey
authors.forename: Claire
authors.initials: C
authors.lastname: Pomeroy
mesh_terms: D000328:Adult; D000748:Anemia, Macrocytic / Q000453:epidemiology*; D019380:Anti-HIV Agents / Q000008:administration & dosage / Q000627:therapeutic use*; D016022:Case-Control Studies; D016009:Chi-Square Distribution; D004909:Erythrocyte Indices; D005260:Female; D015658:HIV Infections / Q000097:blood* / Q000188:drug therapy*; D006801:Humans; D015994:Incidence; D008297:Male; D010349:Patient Compliance; D012189:Retrospective Studies; D018119:Stavudine / Q000008:administration & dosage / Q000627:therapeutic use; D016896:Treatment Outcome; D015215:Zidovudine / Q000627:therapeutic use*
chemical_list: D019380:Anti-HIV Agents; D015215:Zidovudine; D018119:Stavudine