Effect of patient adherence to antiretroviral therapy on CD4+ cell count, HIV-1 RNA, and serum concentrations of tumor necrosis factor and its soluble receptors.
A 1-year prospective analysis of patient adherence to antiretroviral therapy (zidovudine plus zalcitabine [55 patients] or zidovudine plus zalcitabine plus saquinavir [32 patients]) was performed in human immunodeficiency virus (HIV)-infected patients attended at a tertiary care hospital. Adherence to therapy was measured jointly by pharmacy records, patients' self-recording, and an increase in mean corpuscular volume. Likewise, the effects of therapy on clinical parameters, HIV load, CD4+ cell count, and serum levels of tumor necrosis factor alpha (TNF-alpha) and its soluble receptors were analyzed. Twenty-seven patients of those on a double-agent regimen and 12 of those on a triple-agent regimen adhered to the treatment. Ten opportunistic events occurred in noncompliant patients versus none in compliant individuals. A significant increase in CD4+ cell count and a decrease in HIV viral load were observed only in patients who adhered to therapy. TNF and its soluble receptors remained elevated at the end of follow-up, even in patients in whom the HIV viral load decreased to < 400 copies/ml. In conclusion, adherence to therapy must be considered a major factor influencing the results of antiretroviral therapy. Although these treatments have been demonstrated to be efficacious, they are not able to normalize the immune activation markers. These data suggest a suboptimal effect of antiretroviral therapy on the eradication of HIV-1.
Girón-González
J A
JA
Servicio de Medicina Interna, Hospital Universitario Puerta del Mar, Facultad de Medicina, Cádiz, Spain. epgei@comcadiz.es
López-Sánchez
A
A
Elvira
J
J
Perez
E
E
Fernández-Gutiérrez
C
C
D000328:Adult; D019380:Anti-HIV Agents / Q000627:therapeutic use*; D018791:CD4 Lymphocyte Count; D004359:Drug Therapy, Combination; D005260:Female; D015658:HIV Infections / Q000188:drug therapy* / Q000276:immunology / Q000821:virology; D015497:HIV-1 / Q000502:physiology*; D006801:Humans; D008297:Male; D010349:Patient Compliance; D012367:RNA, Viral / Q000097:blood; D018124:Receptors, Tumor Necrosis Factor / Q000097:blood; D018894:Reverse Transcriptase Inhibitors / Q000627:therapeutic use*; D016896:Treatment Outcome; D014409:Tumor Necrosis Factor-alpha / Q000378:metabolism; D019562:Viral Load
D019380:Anti-HIV Agents; D012367:RNA, Viral; D018124:Receptors, Tumor Necrosis Factor; D018894:Reverse Transcriptase Inhibitors; D014409:Tumor Necrosis Factor-alpha