Impact of Early versus Late Adherence to Highly Active Antiretroviral Therapy on Immuno-Virological Response: A 3-Year Follow-Up Study
Year: 2003
Type: article
Study design: Observational Study
Abstract: OBJECTIVE: To assess the impact of different patterns of adherence to highly active antiretroviral therapy (HAART), in particular, the relative impact of early and late adherence, on long-term immuno-virological response in HIV-infected individuals started on a protease inhibitor-containing regimen. DESIGN: Clinical, immuno-virological and self-reported adherence data were collected at 4 (M4), 12 (M12), 20 (M20), 28 (M28) and 36 (M36) months after HAART initiation in the French APROCO cohort. METHODS: A standardized self-administered questionnaire classified patients as non-adherent, moderately or highly adherent at each visit. Stable viral suppression at both M28 to M36, and a CD4 cell increase > 200 between M0 and M36 were used as outcome measures. RESULTS: Of the 582 patients followed regularly through M36, 360 patients had complete adherence data. Although 59.2% were highly adherent at M4, only 25.8% maintained consistent high adherence throughout the follow-up. High adherence at M4 was independently associated with both stable viral suppression at M28-M36 [OR (95% CI): 2.8 (1.4-5.5)] and a CD4 cell increase > 200 during the same period [OR (95% CI): 3.9 (1.7-9.7)]. However, 'moderately adherent' patients between M12 and M36 had the same likelihood [OR (95% CI): 1.9 (1.1-3.2)] as patients who were always high adherent [OR (95% CI): 1.9 (1.1-3.2)] of achieving stable viral load suppression, relative to those who reported non-adherence episodes. CONCLUSION: Optimizing adherence in the early months of treatment is crucial to ensure long-term immuno-virological high adherence during follow-up have a less negative impact. Priority should be given to interventions aimed to improve adherence in the early months of HAART.
Source: Antiviral Therapy
Authors: Maria Patrizia Carrieri, François Raffi, Charlotte Lewden, Alain Sobel, Christian Michelet, Valérie Cailleton, Geneviève Chêne, Catherine Leport, Jean-Paul Moatti, Bruno Spire, the APROCO study group, C Leport, F Raffi, G Chêne, R Salamon, J-P Moatti, J Pierret, F Brun-Vézinet, H Fleury, G Peytavin, R Garraffo, Other members, D Costagliola, P Dellamonica, C Katlama, L Meyer, M Morin, D Sicard, A Sobel, F Ballereau, Observers, M-A Bach, F Bourdillon, P Choutet, J-F Delfraissy, J Dormont, Y Souteyrand, J-L Vildé, M Dupon, V Le Moing, B Marchou, T May, P Morlat, A Waldner-Combernoux, Monitoring and statistical analysis, C Alfaro, S Boucherit, V Cailleton, C Charlois, C Droz, S Duran, JL Ecobichon, C Egouy, V Journot, R Lassalle, L Latour, V Le Moing, C Lewden, B Masquelier, W Nouioua, G Palmer, C Petit, M Préau, S Roloff, M Savès, B Spire, R Winum, Sponsorship, Other supports
Language: English
Subfield: Infectious Diseases
Field: Medicine
Domain: Health Sciences
Open Access status: bronze
OpenAlex ID: W2403142086