Impact of short-term adherence on virological and immunological success of HAART: a case study among French HIV-infected IDUs.
To evaluate the impact of injection drug users (IDUs) adherence on effectiveness of highly active antiretroviral therapy (HAART), repeated measures of plasma viral load and CD4+ counts before HAART initiation and at last visit in the cohort were studied. Data were collected by means of patient's face-to-face and self-administered questionnaires about adherence to HAART during the week prior to the last visit. Of a total of 119 patients treated with HAART, undetectable viral load was obtained for 55 patients (46.2%) (G3); 34 patients (28.6%) (G2) had a viral load decline > 0.5 log copies/ml but still detectable viral load at last visit in the cohort, while 30 patients (25.2%) (G1) had no decline or decline </= 0.5 log copies/ml. Proportion of 100% adherent patients was significantly higher in G3 (83.6%) than in G2 (64.7%) and G1 (56.7%). In spite of differences in virological success and adherence, mean increase in CD4+ counts was similar in G3 (123 +/- 160 counts/mm(3)) and G2 (143 +/- 147) while no immunological improvement was observed in G1. For the sub-groups of patients whose limited adherence has implied virological failure but did not impede short-term immunological reconstitution following HAART initiation, decision to switch HAART regimens could be delayed until interventions for improving future adherence have been carried out.
Pradier
C
C
CISIH, Hôpital de l'Archet, Nice, France.
Carrieri
P
P
Bentz
L
L
Spire
B
B
Dellamonica
P
P
Moreau
J
J
Moatti
J P
JP
D000328:Adult; D023241:Antiretroviral Therapy, Highly Active; D018791:CD4 Lymphocyte Count; D015331:Cohort Studies; D005260:Female; D005602:France; D015658:HIV Infections / Q000150:complications / Q000188:drug therapy* / Q000276:immunology / Q000523:psychology / Q000821:virology; D006801:Humans; D008297:Male; D010349:Patient Compliance / Q000523:psychology; D015819:Substance Abuse, Intravenous / Q000150:complications / Q000523:psychology; D013997:Time Factors; D016896:Treatment Outcome; D019562:Viral Load