title: Adherence to antiretroviral therapy in patients enrolled in a comprehensive care program in Cambodia: a 24-month follow-up assessment.
abstract: BACKGROUND
  The long-term maintenance of antiretroviral therapy (ART) remains an important issue, especially in limited-resource settings where additional barriers exist. A cross-sectional study was performed 24 months after ART initiation for patients treated in Cambodia in order to estimate the prevalence and identify determinants of non-adherence.
  
  
  METHODS
  Adults receiving ART for 24 +/- 2 months were considered eligible for the study. Self-reported non-adherence was defined according to an algorithm based on six items. The questionnaire also assessed ART-related side effects and HIV disclosure. HIV-1 RNA plasma viral load was measured using real-time PCR. Multivariate rare events logistic regression analysis was used to identify independent factors associated with non-adherence.
  
  
  RESULTS
  A total of 346 patients participated in the study. At 24 months, 95% of patients were adherent, 80% had HIV RNA <40 copies/ml and 75% had CD4+ T-cell counts >200 cells/mm3. Virological success was significantly higher in adherent patients than in non-adherent patients (81% versus 56%, P=0.021). Living in a rural area, limited HIV disclosure and perceived lipodystrophy were independently associated with non-adherence.
  
  
  CONCLUSIONS
  At 24 months, adherence to ART was high and explained positive virological outcomes. In order to maintain adherence and long-term virological benefits, special attention should be given to patients living in rural areas, those with lipodystrophy-related symptoms and others who express difficulties disclosing their condition to close family members.
authors.affiliation: Inserm U912, Economic and Social Sciences, Health Systems and Societies, Marseille, France. spire@marseille.inserm.fr
authors.forename: Bruno
authors.initials: B
authors.lastname: Spire
authors.forename: Patrizia
authors.initials: P
authors.lastname: Carrieri
authors.forename: Pal
authors.initials: P
authors.lastname: Sopha
authors.forename: Camelia
authors.initials: C
authors.lastname: Protopopescu
authors.forename: Narom
authors.initials: N
authors.lastname: Prak
authors.forename: Catherine
authors.initials: C
authors.lastname: Quillet
authors.forename: Chanchhaya
authors.initials: C
authors.lastname: Ngeth
authors.forename: Laurent
authors.initials: L
authors.lastname: Ferradini
authors.forename: Jean-François
authors.initials: JF
authors.lastname: Delfraissy
authors.forename: Didier
authors.initials: D
authors.lastname: Laureillard
mesh_terms: D000328:Adult; D019380:Anti-HIV Agents / Q000009:adverse effects / Q000627:therapeutic use*; D002160:Cambodia / Q000453:epidemiology; D003191:Comprehensive Health Care / Q000706:statistics & numerical data*; D003430:Cross-Sectional Studies; D004359:Drug Therapy, Combination; D005260:Female; D015658:HIV Infections / Q000188:drug therapy* / Q000453:epidemiology / Q000821:virology; D015497:HIV-1 / Q000187:drug effects / Q000502:physiology; D006801:Humans; D008297:Male; D010349:Patient Compliance / Q000706:statistics & numerical data*; D015995:Prevalence; D015397:Program Evaluation; D018894:Reverse Transcriptase Inhibitors / Q000009:adverse effects / Q000627:therapeutic use*; D016896:Treatment Outcome; D019562:Viral Load
chemical_list: D019380:Anti-HIV Agents; D018894:Reverse Transcriptase Inhibitors