I've previously highlighted this article
<http://money.cnn.com/news/newsfeeds/articles/prnewswire/CLW02526032008-1.htm>
about a Big Brother device to monitor HIV patients' adherence to
popping their pills:

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InforMedix Holdings, Inc. , announced that results presented by Dr.
David Bangsberg, an internationally renowned expert on medical
adherence, at the Third International Conference on HIV Adherence,
showed that HIV+ patients using its Med-eMonitor(TM) "smart pillbox"
that monitors medication and care plan adherence, achieved an average
89.5% medication adherence rate. The Med- eMonitor "smart pillbox" is
linked to the Med-eXpert(TM) software system that analyzes patient
information and provides Web-enabled reports and urgent outbound
alerts to caregivers when patients miss medication or suffer declining
health.

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My full message can be read here:
<http://groups.google.co.uk/group/misc.health.aids/msg/474a4890f7854afd>.

It appears that boffins elsewhere have been working on a similar Big
Brother machine.  Their alternative device requires a breath sample
from HIV pill poppers to monitor adherence to their HIV wonder drug
regime.

<http://www.sciencedaily.com/releases/2008/04/080421121947.htm>:

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Most of us have missed a dose of antibiotic or forgotten to take a
daily vitamin. But when the stakes are higher -- as they are for
people with HIV/AIDS -- a skipped pill could mean the difference
between health and hazard for the entire population.

Now, a breath monitoring device developed by scientists at the
University of Florida and Xhale Inc. could help prevent the emergence
of drug-resistant strains of HIV by monitoring medication adherence in
high-risk individuals.

"For HIV, it's been shown that if you don't take a very high
percentage of your medication, you may as well not take medication at
all," said Richard Melker, M.D., a professor of anesthesiology at the
UF College of Medicine and chief technology officer for Xhale.

Patients who take some but not all of their medication increase the
likelihood the virus will mutate into a deadlier, drug-resistant form.
Experts have tried literally hundreds, if not thousands, of ways to
monitor drug adherence, ranging from daily log books to blister packs
that record the time each pill is dispensed. Despite the money, time
and effort devoted to these methods, Melker said only one works well:
directly observed therapy, or DOT.

"If you have a disease that is deemed to be a public health risk,
authorities can put you into a program where you have to come to the
clinic every day and be observed putting the pill into your mouth and
swallowing it," Melker said.

But that process is inconvenient for patients, as well as for clinic
personnel who have to track them down when they fail to show up. A
breath-monitoring device developed by UF scientists and Xhale could
change that, allowing patients to participate in a type of virtual DOT
from home.

"The machine sits in your home and when it's time for you to take your
medication, it makes a beeping noise. If you don't hit a button after
about five minutes, it's going to beep louder and louder until you
come," Melker said. "If you don't come after a certain amount of time,
the machine can call the clinical trial coordinator and indicate that
subject or patient didn't take the medication as prescribed."

The device, which is slightly smaller than a shoebox, records the
results of each breath test, allowing patients to bring a memory card
or USB key to the clinic once a month and receive a printout of their
results. Eventually, the researchers hope to reduce the size of their
detection device to fit inside a cell phone. But for now, they're
satisfied that the technology works.

"The doctor can see how often you took it and exactly what time. If it
made the patient really sick or dizzy and they didn't take it, they
can find out why," Melker said. "It's not just a question of did I or
didn't I take it, but when you took it or why you didn't take it."

The researchers developed the adherence monitor by incorporating
minute amounts of an alcohol into a gel capsule. The additive, called
2-butanol, is one of many GRAS -- Generally Recognized as Safe --
compounds approved by the Food and Drug Administration for use in
foods.

"We wanted (patients) to swallow a chemical and have it transform into
something else that's easy to monitor," said Matthew Booth, Ph.D., an
assistant professor of anesthesiology at the UF College of Medicine
and an investigator in the study. "When it hits the stomach lining and
liver, an enzyme converts the alcohol to a gas that can be measured in
the breath."

To determine how well the byproduct could be detected, six healthy
volunteers swallowed empty pills in which the capsules contained trace
amounts of 2-butanol. After five to 10 minutes, the scientists could
measure the volatile byproduct in the volunteers' breath using a small
detector. The scientists say their device could also be used to
monitor medication adherence in patients with other communicable
diseases, such as tuberculosis.

"It is encouraging that the biological and chemical elements of the
adherence system work as predicted. We were able to conclusively show
who swallowed the capsules containing the 2-butanol. With further
optimization, we are optimistic the device will perform very well,"
said Donn Dennis, M.D., the Joachim S. Gravenstein professor of
anesthesiology at the UF College of Medicine and an investigator in
the study.

The researchers say the device may prove equally helpful for
monitoring adherence in clinical trials.

"If you enroll HIV/AIDS patients in a clinical trial and they don't
take the medication, then you may not get adequate proof that the drug
is effective," Melker said. "It might be effective, but some of the
patients aren't taking it."

Phase 2 trials are often conducted in the community, rather than at
research institutions, making it difficult for researchers to monitor
adherence. As a result, many trials enroll a larger group of subjects
than needed, in hopes they'll obtain enough data to determine the
safety and efficacy of the medication.

"If we had a good way of doing DOT that's realistic, instead of having
someone come to your house or you going to clinic every day of your
life, then we would know whether these people stopped taking their
medication and why. Right now, nobody knows any of that." Melker said.
"The implications of being able to understand what normal human
behavior is in a clinical trial and, of course, in the real world, are
huge."

Adapted from materials provided by University of Florida.

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I wonder why HIV patients are so careless about taking their
"life-saving medication" correctly?

I'll answer my own question: it's because the medication has
horrendous side-effects and offers no benefits.

I'd be surprised if all but a small number of diehard HIVers took
their HIV medication as and when they should.