Abstract
BackgroundSeveral previous studies have shown relationships between adherence to HIV antiretroviral therapy (ART) and the viral load, the CD4 cell count, or mortality. However, the impact of variability in adherence to ART on the immunovirological response does not seem to have been investigated yet.MethodsMonthly adherence data (November 1999 to April 2009) from 317 HIV-1 infected patients enrolled in the Senegalese ART initiative were analyzed. Latent-class trajectory models were used to build typical trajectories for the average adherence and the standardized variance of adherence. The relationship between the standardized variance of adherence and each of the change in CD4 cell count, the change in viral load, and mortality were investigated using, respectively, a mixed linear regression, a mixed logistic regression, and a Cox model with time-dependent covariates. All the models were adjusted on the average adherence.ResultsThree latent trajectories for the average adherence and three for the standardized variance of adherence were identified. The increase in CD4 cell count and the increase in the percentage of undetectable viral loads were negatively associated with the standardized variance of adherence but positively associated with the average adherence. The risk of death decreased significantly with the increase in the average adherence but increased significantly with the increase of the standardized variance of adherence.ConclusionsThe impacts of the level and the variability of adherence on the immunovirological response and survival justify the inclusion of these aspects into the process of patient education: adherence should be both high and constant.Electronic supplementary materialThe online version of this article (doi:10.1186/1471-2288-15-10) contains supplementary material, which is available to authorized users.
Highlights
Several previous studies have shown relationships between adherence to HIV antiretroviral therapy (ART) and the viral load, the CD4 cell count, or mortality
Two decades ago, the advent of highly active antiretroviral therapy (HAART) has improved the health status of many people living with HIV and has significantly reduced HIV-linked death rates [1,2]
In the group of DrI average adherence, though not significant, the associations between the standardized variance of adherence to HAART and viral load detectability showed the same trend as in the group of cH average adherence (Moderate vs. High variance: OR = 1.28; 95% CI: 0.64–2.58 and Low vs. High variance: OR = 1.73; 95% CI: 0.75–4.00)
Summary
Several previous studies have shown relationships between adherence to HIV antiretroviral therapy (ART) and the viral load, the CD4 cell count, or mortality. Several studies have shown the relationships between adherence to HAART and each of: plasma viral load, CD4 recovery, the progression toward AIDS, or mortality [3,4,5,6,7,8]: For various reasons, unlike the case in high-income countries, the rate of access to HAART in most SubSaharan African countries has long been low [9,10]: less than 4% [9]. ISAARV and the follow-up project have been the object of several studies over various time periods These studies have analyzed the determinants of adherence, the levels of adherence, and the link between the level of adherence and the immunovirological response or mortality [13,14,15]
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