title: Impact of early versus late adherence to highly active antiretroviral therapy on immuno-virological response: a 3-year follow-up 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.
  
  
  METHODS
  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.
  
  
  CONCLUSIONS
  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.
authors.affiliation: INSERM U379, Marseille, France.
authors.forename: Maria Patrizia
authors.initials: MP
authors.lastname: Carrieri
authors.forename: François
authors.initials: F
authors.lastname: Raffi
authors.forename: Charlotte
authors.initials: C
authors.lastname: Lewden
authors.forename: Alain
authors.initials: A
authors.lastname: Sobel
authors.forename: Christian
authors.initials: C
authors.lastname: Michelet
authors.forename: Valérie
authors.initials: V
authors.lastname: Cailleton
authors.forename: Geneviève
authors.initials: G
authors.lastname: Chêne
authors.forename: Catherine
authors.initials: C
authors.lastname: Leport
authors.forename: Jean-Paul
authors.initials: JP
authors.lastname: Moatti
authors.forename: Bruno
authors.initials: B
authors.lastname: Spire
mesh_terms: D000163:Acquired Immunodeficiency Syndrome / Q000188:drug therapy* / Q000276:immunology / Q000821:virology; D000328:Adult; D023241:Antiretroviral Therapy, Highly Active; D018791:CD4 Lymphocyte Count; D016516:CD4-CD8 Ratio; D005260:Female; D005500:Follow-Up Studies; D015497:HIV-1; D006801:Humans; D008297:Male; D008875:Middle Aged; D010349:Patient Compliance; D012367:RNA, Viral / Q000097:blood; D013997:Time Factors
chemical_list: D012367:RNA, Viral