Back To Search Results


Editor: Ahmed Munir Updated: 5/1/2022 9:16:24 AM

Abacavir is an FDA-approved drug used to treat HIV-1 infection in conjunction with other antiretrovirals. Like other nucleoside reverse-transcriptase inhibitors (NRTIs), abacavir use is typically combined with other HIV medications. Abacavir is not recommended for use by itself.[1] It can be taken by mouth as a tablet or solution, and it is a treatment option in patients over the age of three months.[2] Commonly, abacavir is dispensed with other HIV medications such as abacavir/lamivudine/zidovudine, abacavir/dolutegravir/lamivudine, and abacavir/lamivudine.[3]

Singh R. et al. conducted a clinical trial with abacavir 600 mg/dolutegravir 50 mg/lamivudine 300 mg on 12 patients (four men and eight women) of Japanese ancestry to determine the safety and pharmacokinetics in a single dose tablet after fasting for eight hours. Many clinical trials are conducted with patients of European ancestry. It is helpful to enroll patients of many different ethnic backgrounds to determine any differences in the pharmacokinetics and safety of the medications being studied. The researchers collected blood samples over 72 hours after dosing to determine several pharmacokinetic parameters. The geometric mean maximum plasma concentrations for abacavir, dolutegravir, and lamivudine were 5.22, 4.13, and 3.35 micrograms/ml, respectively. The time to maximum concentration for abacavir, dolutegravir, and lamivudine were 1.01, 3.50, and 2.98 hours, respectively. The geometric mean area under the concentration-time curve for abacavir, dolutegravir, and lamivudine was 18.2, 71.6, and 16.6 micrograms times hour per ml. The research subjects did not report any adverse drug effects. The pharmacokinetic parameters for abacavir and lamivudine were similar to previously reported clinical trial data from healthy Japanese and European or African ancestry subjects. Dolultegravir was found to have a higher area under the concentration-time curve in this study compared with the two previously mentioned studies.[4]

Archary M. et al. conducted a study on the pharmacokinetics of abacavir and lamivudine in severely malnourished children (N = 75) with human immunodeficiency virus from South Africa. The children's ages ranged from 0.1 to 10.8 years and were dosed based on World Health Organization (WHO) weight-band recommendations. The children were randomized to receive treatment with abacavir and lamivudine within 14 days (early) or after nutritional recovery (delayed). Abacavir and lamivudine pharmacokinetic parameters were measured on days 1 and 14. The children received follow-up to week 48. Abacavir demonstrated a 2-compartment pharmacokinetic model. The early treatment cohort demonstrated a 31% increase in their bioavailability of abacavir. The apparent clearance (CL/F) of abacavir increased from a mean of 3.33 to 5.86 L/Hr/7 kg from day 1 to day 14. Lamivudine demonstrated an A 1-compartment pharmacokinetic model. Variability in the apparent clearance was best explained by age maturation. Archary M. et al. concluded that the WHO weight-band dosing recommendations are appropriate, and the pharmacokinetic variability of abacavir and lamivudine treatment in severely malnourished children did not affect its efficacy.[5]

Mechanism of Action

Earn CME credit as you help guide your clinical decisions.
Get the answers you need instantly with the StatPearls Clinical Decision Support tool. StatPearls spent the last decade developing the largest and most updated Point-of Care resource ever developed.


$59 per month


$599 per year

Abacavir is a nucleoside reverse transcriptase inhibitor. Within this class, it is specifically a carbocyclic 2'-deoxyguanosine, also known as a guanosine analog. After oral ingestion, abacavir sulfate is rapidly absorbed and reaches peak concentrations at about 0.63 to 1 hour with an absolute bioavailability of about 83%. Abacavir displays linear pharmacokinetics and possesses dose proportionality over the range of 300 to 1200 mg/day. Taking abacavir with food has not had any clinically relevant effect on exposure to the drug and can be safely ingested in the presence or absence of food. The volume of distribution by parental route is about 0.86 +/- 0.15 L/kg. Plasma protein binding is about 50% and has an independent relationship with the plasma concentration of the drug.

Abacavir is predominantly metabolized by the liver. The remaining bioavailable 2% of the compound gets excreted as an unaltered product in the urine. Two major metabolic pathways are the uridine diphosphate glucuronyltransferase and the alcohol dehydrogenase pathway processes abacavir within the liver. Enzymatic metabolism produces an inactive glucuronide metabolite (361W94, approximately 36% of the dose recovered in the urine) and an additional inactive carboxylate metabolite (2269W93, about 30% of the dose recovered in the urine) — the other 15% of the compound ends up in the urine as minor metabolites, which comprise less than 2% of the orally ingested amount. Elimination through stool makes up about 16% of the original dose. CYP450 metabolism of abacavir does not play a substantial role in abacavir, and no observable drug interactions that alter clinical decision-making exist within recommended doses of methadone, zidovudine, and lamivudine. Also, there appears to be no interaction with ethanol. [6]

The antiviral effect of abacavir is due to its intracellular anabolite, carbovir-triphosphate, which interferes with HIV viral RNA-dependent DNA polymerase (reverse transcriptase), leading to inhibition of viral replication.[7] This intracellular anabolite has been shown to have a long elimination half-life of greater than 20 hours, allowing for once-daily dosing.[6]

Abacavir is administered as 300 mg twice daily or 600 mg once daily. It is also available as part of several co-formulated tablets. These different co-formulations are part of nucleoside/nucleotide reverse transcriptase inhibitors (NRTIs) drug combinations.[8]

There are no dosage adjustments recommended in patients with renal impairment, and abacavir is well-tolerated in patients that would benefit from NRTI use with renal pathology from other antiretrovirals.[9] The recommendation is to dose-adjust in hepatic impairment. Mild hepatic impairment denoted as Child-Pugh class A is suggested at 200 mg twice daily as an oral solution. Due to a lack of safety data, contraindications to abacavir include moderate to severe hepatic impairment, Child-Pugh class B or C.[6]

The common toxicities of the NRTI class are mitochondrial toxicity, which can present as hepatic steatosis, lipoatrophy, pancreatitis, and peripheral neuropathy.[10] Symptomatic lactic acidosis can also occur in patients, and these require monitoring due to an increased risk of mortality.[11] Additionally, patients on long-term antiretroviral therapy (ART) may experience fat redistribution: lipodystrophy.[12]

Clinicians should avoid abacavir in patients with coronary artery disease and those at increased risk of myocardial infarction due to an increased risk of hyperlipidemia and cardiovascular events.[13][14][15]

Contraindications to abacavir in ART therapy include hypersensitivity to abacavir or any formulation component, moderate to severe hepatic impairment, and patients who are positive for the HLA-B*5701 allele. This allele is highest in Caucasian populations at a frequency of 5 to 8%.[16] Also, in patients with moderate to severe hepatic impairment, Child-Pugh class B or C, abacavir administration is relatively contraindicated due to a lack of safety studies.[6]

Abacavir should also be avoided and is relatively contraindicated in individuals who test positive for HLA-DR7 and HLA-DQ3 alleles because evidence shows that switching abacavir for another NRTI leads to a reduced incidence of hypersensitivity reactions.[17]

There is some potential for drug-induced injury to the body that requires monitoring when administering abacavir to patients with HIV. Patients should receive screening for HLA-B*57101 genotype status before starting therapy and before continuing treatment in patients with unknown HLA-B*57101 status. Patients should have CBC with differential, serum creatinine kinase, CD4 count, HIV RNA plasma concentrations, triglycerides, and serum amylases monitored periodically.[16] Clinicians should be aware of the risk for acute and late-onset hepatotoxicity and monitor AST and ALT concentrations.[18] Signs of central fat gain or lipoatrophy should be assessed for fat gain or fat loss to fine-tune ART therapy.[19]


Serious and sometimes fatal hypersensitivity reactions can potentially occur with abacavir. Patients who possess the HLA-B*5701 allele also carry a higher risk for a hypersensitivity reaction to abacavir; however, hypersensitivity reactions have occurred in those who do not carry the HLA-B*5701 allele. All patients should receive screening for the HLA-B*5701 allele.[16]

Enhancing Healthcare Team Outcomes

Managing the administration of abacavir to HIV patients requires an interprofessional team of healthcare professionals that includes a nurse, laboratory technologists, pharmacists, social workers, and several physicians in different specialties. After HIV diagnosis, prompt admission into HIV medical and adherence/retention in that care is fundamental to the administration of effective antiretroviral therapy. Adherence to antiretroviral therapy (ART) is one of the top factors of favorable HIV treatment outcomes and is necessary to decrease the occurrence of drug resistance within the patient. Common obstacles to successful ART stem from an absence of social support and alcohol or substance abuse, which prevent patients from having sustained therapy.

The emphasis on adherence cannot be overemphasized. Clinicians, specialists, nurses, and pharmacists all must share in the effort to educate the patient and monitor pharmacotherapy adherence. For example, if the patient is chronically late in picking up their prescription, meaning there will be days without therapy, the pharmacist must call the physician's office and share this information with the nurse or prescriber. The pharmacist is also responsible for medication reconciliation and verifying dosing parameters. On follow-up visits, the nurse must verify adherence and should do so by asking open-ended questions that encourage the patient to reveal familiarity with their regimen. Failure to take the drugs in ART correctly can result in therapeutic failure for the entire drug class, as the virus can obtain adaptive drug resistance; this is why any type of ART requires open, interprofessional team communication to ensure the best chance for therapeutic success. [Level 5]

Recommendations for Increasing Successful Outcomes in Antiretroviral Therapy 

  • Initiation of highly active antiretroviral therapy (HAART) with a high degree of adherence, defined as greater than 95% refills and plasma drug concentrations above the therapeutic steady-state concentration, is associated with low levels of antiretroviral resistance.[20] [Level 1]
  • Individual-level monitoring of entry and retention is a strong recommendation for all people diagnosed with HIV.[21][22] [Level 1]
  • Systematic retention monitoring in HIV care is also strongly recommended for all HIV patients.[23] [Level 3]
  • Strengths-based case management from trained social workers increases entry to HIV medical care.[24] [Level 1]
  • Self-report adherence should be obtained routinely in all HIV patients.[25] [Level 3]
  • Regimens of similar efficacy and tolerability, once-daily regimens are recommended in treatment naïve patients starting ART, as well as experienced patients receiving poorly tolerated/complex regimens.[25][26][27][28] [Level 1]
  • Reminders and the use of communication technologies with an interactive component are recommended to increase adherence [29] [Level 1]
  • Combining education and counseling using specific adherence-related tools is recommended for all patients with HIV.[30][31][32][Level 1]
  • Directly administered ART (DART) is the recommended course of action in individuals with substance use disorders.[33][34][35] [Level 2]
  • Cognitive-behavioral therapy is recommended in patients with depression to improve adherence.[36] [Level 2]



Park MS, Yang YM, Kim JS, Choi EJ. Comparative study of antiretroviral drug regimens and drug-drug interactions between younger and older HIV-infected patients at a tertiary care teaching hospital in South Korea. Therapeutics and clinical risk management. 2018:14():2229-2241. doi: 10.2147/TCRM.S175704. Epub 2018 Nov 12     [PubMed PMID: 30519031]

Level 2 (mid-level) evidence


Katlama C, Ingrand D, Loveday C, Clumeck N, Mallolas J, Staszewski S, Johnson M, Hill AM, Pearce G, McDade H. Safety and efficacy of lamivudine-zidovudine combination therapy in antiretroviral-naive patients. A randomized controlled comparison with zidovudine monotherapy. Lamivudine European HIV Working Group. JAMA. 1996 Jul 10:276(2):118-25     [PubMed PMID: 8656503]

Level 1 (high-level) evidence


Greig SL, Deeks ED. Abacavir/dolutegravir/lamivudine single-tablet regimen: a review of its use in HIV-1 infection. Drugs. 2015 Apr:75(5):503-14. doi: 10.1007/s40265-015-0361-6. Epub     [PubMed PMID: 25698454]


Singh RP, Adkison K, Wolstenholme A, Hopking J, Wynne B. Pharmacokinetics, Safety, and Tolerability of a Single Oral Dose of Abacavir/Dolutegravir/Lamivudine Combination Tablets in Healthy Japanese Study Participants. Clinical pharmacology in drug development. 2021 Sep:10(9):985-993. doi: 10.1002/cpdd.996. Epub 2021 Jul 15     [PubMed PMID: 34265164]


Archary M, Mcllleron H, Bobat R, LaRussa P, Sibaya T, Wiesner L, Hennig S. Population pharmacokinetics of abacavir and lamivudine in severely malnourished human immunodeficiency virus-infected children in relation to treatment outcomes. British journal of clinical pharmacology. 2019 Sep:85(9):2066-2075. doi: 10.1111/bcp.13998. Epub 2019 Jul 7     [PubMed PMID: 31141195]


Yuen GJ, Weller S, Pakes GE. A review of the pharmacokinetics of abacavir. Clinical pharmacokinetics. 2008:47(6):351-71     [PubMed PMID: 18479171]


Anderson PL, Kakuda TN, Kawle S, Fletcher CV. Antiviral dynamics and sex differences of zidovudine and lamivudine triphosphate concentrations in HIV-infected individuals. AIDS (London, England). 2003 Oct 17:17(15):2159-68     [PubMed PMID: 14523272]


Saag MS, Benson CA, Gandhi RT, Hoy JF, Landovitz RJ, Mugavero MJ, Sax PE, Smith DM, Thompson MA, Buchbinder SP, Del Rio C, Eron JJ Jr, Fätkenheuer G, Günthard HF, Molina JM, Jacobsen DM, Volberding PA. Antiretroviral Drugs for Treatment and Prevention of HIV Infection in Adults: 2018 Recommendations of the International Antiviral Society-USA Panel. JAMA. 2018 Jul 24:320(4):379-396. doi: 10.1001/jama.2018.8431. Epub     [PubMed PMID: 30043070]


Postorino MC, Quiros-Roldan E, Maggiolo F, Di Giambenedetto S, Ladisa N, Lapadula G, Lorenzotti S, Sighinolfi L, Castelnuovo F, Di Pietro M, Gotti D, Mazzini N, Torti C, MASTER Study Group. Exploratory Analysis for the Evaluation of Estimated Glomerular Filtration Rate, Cholesterol and Triglycerides after Switching from Tenofovir/Emtricitabine plus Atazanavir/Ritonavir (ATV/r) to Abacavir/Lamivudine plus ATV/r in Patients with Preserved Renal Function. The open AIDS journal. 2016:10():136-43. doi: 10.2174/1874613601610010136. Epub 2016 Jul 15     [PubMed PMID: 27563366]


Boubaker K, Flepp M, Sudre P, Furrer H, Haensel A, Hirschel B, Boggian K, Chave JP, Bernasconi E, Egger M, Opravil M, Rickenbach M, Francioli P, Telenti A. Hyperlactatemia and antiretroviral therapy: the Swiss HIV Cohort Study. Clinical infectious diseases : an official publication of the Infectious Diseases Society of America. 2001 Dec 1:33(11):1931-7     [PubMed PMID: 11692306]


Coghlan ME, Sommadossi JP, Jhala NC, Many WJ, Saag MS, Johnson VA. Symptomatic lactic acidosis in hospitalized antiretroviral-treated patients with human immunodeficiency virus infection: a report of 12 cases. Clinical infectious diseases : an official publication of the Infectious Diseases Society of America. 2001 Dec 1:33(11):1914-21     [PubMed PMID: 11692304]

Level 3 (low-level) evidence


Carr A. HIV lipodystrophy: risk factors, pathogenesis, diagnosis and management. AIDS (London, England). 2003 Apr:17 Suppl 1():S141-8     [PubMed PMID: 12870540]


Strategies for Management of Anti-Retroviral Therapy/INSIGHT, DAD Study Groups. Use of nucleoside reverse transcriptase inhibitors and risk of myocardial infarction in HIV-infected patients. AIDS (London, England). 2008 Sep 12:22(14):F17-24. doi: 10.1097/QAD.0b013e32830fe35e. Epub     [PubMed PMID: 18753925]


D:A:D Study Group, Sabin CA, Worm SW, Weber R, Reiss P, El-Sadr W, Dabis F, De Wit S, Law M, D'Arminio Monforte A, Friis-Møller N, Kirk O, Pradier C, Weller I, Phillips AN, Lundgren JD. Use of nucleoside reverse transcriptase inhibitors and risk of myocardial infarction in HIV-infected patients enrolled in the D:A:D study: a multi-cohort collaboration. Lancet (London, England). 2008 Apr 26:371(9622):1417-26. doi: 10.1016/S0140-6736(08)60423-7. Epub 2008 Apr 2     [PubMed PMID: 18387667]


Marcus JL, Neugebauer RS, Leyden WA, Chao CR, Xu L, Quesenberry CP Jr, Klein DB, Towner WJ, Horberg MA, Silverberg MJ. Use of Abacavir and Risk of Cardiovascular Disease Among HIV-Infected Individuals. Journal of acquired immune deficiency syndromes (1999). 2016 Apr 1:71(4):413-9. doi: 10.1097/QAI.0000000000000881. Epub     [PubMed PMID: 26536316]


Lucas A, Nolan D, Mallal S. HLA-B*5701 screening for susceptibility to abacavir hypersensitivity. The Journal of antimicrobial chemotherapy. 2007 Apr:59(4):591-3     [PubMed PMID: 17317695]


Mallal S, Nolan D, Witt C, Masel G, Martin AM, Moore C, Sayer D, Castley A, Mamotte C, Maxwell D, James I, Christiansen FT. Association between presence of HLA-B*5701, HLA-DR7, and HLA-DQ3 and hypersensitivity to HIV-1 reverse-transcriptase inhibitor abacavir. Lancet (London, England). 2002 Mar 2:359(9308):727-32     [PubMed PMID: 11888582]


Christensen ES, Jain R, Roxby AC. Abacavir/Dolutegravir/Lamivudine (Triumeq)-Induced Liver Toxicity in a Human Immunodeficiency Virus-Infected Patient. Open forum infectious diseases. 2017 Summer:4(3):ofx122. doi: 10.1093/ofid/ofx122. Epub 2017 Jun 12     [PubMed PMID: 28748198]


de Waal R, Cohen K, Maartens G. Systematic review of antiretroviral-associated lipodystrophy: lipoatrophy, but not central fat gain, is an antiretroviral adverse drug reaction. PloS one. 2013:8(5):e63623. doi: 10.1371/journal.pone.0063623. Epub 2013 May 28     [PubMed PMID: 23723990]

Level 1 (high-level) evidence


Harrigan PR, Hogg RS, Dong WW, Yip B, Wynhoven B, Woodward J, Brumme CJ, Brumme ZL, Mo T, Alexander CS, Montaner JS. Predictors of HIV drug-resistance mutations in a large antiretroviral-naive cohort initiating triple antiretroviral therapy. The Journal of infectious diseases. 2005 Feb 1:191(3):339-47     [PubMed PMID: 15633092]


Cohen MS, Chen YQ, McCauley M, Gamble T, Hosseinipour MC, Kumarasamy N, Hakim JG, Kumwenda J, Grinsztejn B, Pilotto JH, Godbole SV, Mehendale S, Chariyalertsak S, Santos BR, Mayer KH, Hoffman IF, Eshleman SH, Piwowar-Manning E, Wang L, Makhema J, Mills LA, de Bruyn G, Sanne I, Eron J, Gallant J, Havlir D, Swindells S, Ribaudo H, Elharrar V, Burns D, Taha TE, Nielsen-Saines K, Celentano D, Essex M, Fleming TR, HPTN 052 Study Team. Prevention of HIV-1 infection with early antiretroviral therapy. The New England journal of medicine. 2011 Aug 11:365(6):493-505. doi: 10.1056/NEJMoa1105243. Epub 2011 Jul 18     [PubMed PMID: 21767103]

Level 3 (low-level) evidence


Metsch LR, Pereyra M, Messinger S, Del Rio C, Strathdee SA, Anderson-Mahoney P, Rudy E, Marks G, Gardner L, Antiretroviral Treatment and Access Study (ARTAS) Study Group. HIV transmission risk behaviors among HIV-infected persons who are successfully linked to care. Clinical infectious diseases : an official publication of the Infectious Diseases Society of America. 2008 Aug 15:47(4):577-84. doi: 10.1086/590153. Epub     [PubMed PMID: 18624629]


Tripathi A, Youmans E, Gibson JJ, Duffus WA. The impact of retention in early HIV medical care on viro-immunological parameters and survival: a statewide study. AIDS research and human retroviruses. 2011 Jul:27(7):751-8. doi: 10.1089/AID.2010.0268. Epub 2011 Jan 15     [PubMed PMID: 21142607]


Gardner LI, Metsch LR, Anderson-Mahoney P, Loughlin AM, del Rio C, Strathdee S, Sansom SL, Siegal HA, Greenberg AE, Holmberg SD, Antiretroviral Treatment and Access Study Study Group. Efficacy of a brief case management intervention to link recently diagnosed HIV-infected persons to care. AIDS (London, England). 2005 Mar 4:19(4):423-31     [PubMed PMID: 15750396]

Level 3 (low-level) evidence


Deschamps AE, De Geest S, Vandamme AM, Bobbaers H, Peetermans WE, Van Wijngaerden E. Diagnostic value of different adherence measures using electronic monitoring and virologic failure as reference standards. AIDS patient care and STDs. 2008 Sep:22(9):735-43. doi: 10.1089/apc.2007.0229. Epub     [PubMed PMID: 18754705]


Molina JM, Podsadecki TJ, Johnson MA, Wilkin A, Domingo P, Myers R, Hairrell JM, Rode RA, King MS, Hanna GJ. A lopinavir/ritonavir-based once-daily regimen results in better compliance and is non-inferior to a twice-daily regimen through 96 weeks. AIDS research and human retroviruses. 2007 Dec:23(12):1505-14     [PubMed PMID: 18160008]


Boyle BA, Jayaweera D, Witt MD, Grimm K, Maa JF, Seekins DW. Randomization to once-daily stavudine extended release/lamivudine/efavirenz versus a more frequent regimen improves adherence while maintaining viral suppression. HIV clinical trials. 2008 May-Jun:9(3):164-76. doi: 10.1310/hct0903-164. Epub     [PubMed PMID: 18547903]


Dejesus E, Young B, Morales-Ramirez JO, Sloan L, Ward DJ, Flaherty JF, Ebrahimi R, Maa JF, Reilly K, Ecker J, McColl D, Seekins D, Farajallah A, AI266073 Study Group. Simplification of antiretroviral therapy to a single-tablet regimen consisting of efavirenz, emtricitabine, and tenofovir disoproxil fumarate versus unmodified antiretroviral therapy in virologically suppressed HIV-1-infected patients. Journal of acquired immune deficiency syndromes (1999). 2009 Jun 1:51(2):163-74. doi: 10.1097/QAI.0b013e3181a572cf. Epub     [PubMed PMID: 19357529]


Lester RT, Ritvo P, Mills EJ, Kariri A, Karanja S, Chung MH, Jack W, Habyarimana J, Sadatsafavi M, Najafzadeh M, Marra CA, Estambale B, Ngugi E, Ball TB, Thabane L, Gelmon LJ, Kimani J, Ackers M, Plummer FA. Effects of a mobile phone short message service on antiretroviral treatment adherence in Kenya (WelTel Kenya1): a randomised trial. Lancet (London, England). 2010 Nov 27:376(9755):1838-45. doi: 10.1016/S0140-6736(10)61997-6. Epub 2010 Nov 9     [PubMed PMID: 21071074]

Level 1 (high-level) evidence


Mannheimer SB, Morse E, Matts JP, Andrews L, Child C, Schmetter B, Friedland GH, Terry Beirn Community Programs for Clinical Research on AIDS. Sustained benefit from a long-term antiretroviral adherence intervention. Results of a large randomized clinical trial. Journal of acquired immune deficiency syndromes (1999). 2006 Dec 1:43 Suppl 1():S41-7     [PubMed PMID: 17091022]

Level 1 (high-level) evidence


de Bruin M, Hospers HJ, van Breukelen GJ, Kok G, Koevoets WM, Prins JM. Electronic monitoring-based counseling to enhance adherence among HIV-infected patients: a randomized controlled trial. Health psychology : official journal of the Division of Health Psychology, American Psychological Association. 2010 Jul:29(4):421-8. doi: 10.1037/a0020335. Epub     [PubMed PMID: 20658830]

Level 1 (high-level) evidence


Sabin LL, DeSilva MB, Hamer DH, Xu K, Zhang J, Li T, Wilson IB, Gill CJ. Using electronic drug monitor feedback to improve adherence to antiretroviral therapy among HIV-positive patients in China. AIDS and behavior. 2010 Jun:14(3):580-9. doi: 10.1007/s10461-009-9615-1. Epub     [PubMed PMID: 19771504]


Altice FL, Maru DS, Bruce RD, Springer SA, Friedland GH. Superiority of directly administered antiretroviral therapy over self-administered therapy among HIV-infected drug users: a prospective, randomized, controlled trial. Clinical infectious diseases : an official publication of the Infectious Diseases Society of America. 2007 Sep 15:45(6):770-8     [PubMed PMID: 17712763]

Level 1 (high-level) evidence


Macalino GE, Hogan JW, Mitty JA, Bazerman LB, Delong AK, Loewenthal H, Caliendo AM, Flanigan TP. A randomized clinical trial of community-based directly observed therapy as an adherence intervention for HAART among substance users. AIDS (London, England). 2007 Jul 11:21(11):1473-7     [PubMed PMID: 17589194]

Level 1 (high-level) evidence


Maru DS, Bruce RD, Walton M, Springer SA, Altice FL. Persistence of virological benefits following directly administered antiretroviral therapy among drug users: results from a randomized controlled trial. Journal of acquired immune deficiency syndromes (1999). 2009 Feb 1:50(2):176-81. doi: 10.1097/QAI.0b013e3181938e7e. Epub     [PubMed PMID: 19131891]

Level 1 (high-level) evidence


Safren SA, O'Cleirigh C, Tan JY, Raminani SR, Reilly LC, Otto MW, Mayer KH. A randomized controlled trial of cognitive behavioral therapy for adherence and depression (CBT-AD) in HIV-infected individuals. Health psychology : official journal of the Division of Health Psychology, American Psychological Association. 2009 Jan:28(1):1-10. doi: 10.1037/a0012715. Epub     [PubMed PMID: 19210012]

Level 1 (high-level) evidence