Mesure de l’efficacité et de l’observance du traitement antirétroviral chez des patients infectés par le VIH au Cameroun

Abstract

Objective The aim of the study was to identify the most useful clinical criteria to measure effectiveness and adherence to antiretroviral treatment in a rural area of Cameroon. Patients and method All patients under antiretroviral therapy followed for at least 3 months at the Tokombéré UPEC hospital were eligible. Therapeutic failure was defined according to clinical criteria including weight, Karnofsky's index, or occurrence of WHO stage IV conditions. The criteria for drug adherence were based on patient statement (drugs taken over the last 4 days) and pharmacy-controlled drug delivery. Patient sociodemographic characteristics were collected via a questionnaire. Results Fifty-six patients were included, most of whom were at AIDS stage on treatment initiation. The mean duration of antiretroviral therapy was 1 year. 21, 10, and 19% of patients were in therapeutic failure according to “weight”, “Karnofsky's index”, and “WHO stage IV”, respectively. Non-adherence was reported in 5% of patients according to the declarative method and 20% according to pharmacy controlled drug delivery. Weight modification during treatment was significantly correlated with the evolution of Karnofsky's index ( p = 0.03). A significant correlation between therapeutic failure and non-observance was only found when using the weight criterion and the declarative method ( p = 0.004). Conclusion The effectiveness and adherence to antiretroviral therapy can be evaluated by simple clinical criteria. Using these criteria can be recommended in rural areas until access to biological follow-up becomes available in developing countries.