title: Assessment of the impact of adherence and other predictors during HAART on various CD4 cell responses in resource-limited settings.
abstract: OBJECTIVE
  The aim of this study was to quantify, by modeling, the impact of significant predictors on CD4 cell response during antiretroviral therapy in a resource-limited setting.
  
  
  METHODS
  Modeling was used to determine which antiretroviral therapy response predictors (baseline CD4 cell count, clinical state, age, and adherence) significantly influence immunological response in terms of CD4 cell gain compared to a reference value at different periods of monitoring.
  
  
  RESULTS
  At 6 months, CD4 cell response was significantly influenced by baseline CD4 count alone. The probability of no increase in CD4 cells was 2.6 higher in patients with a baseline CD4 cell count of ≥200/mm(3). At 12 months, CD4 cell response was significantly influenced by both baseline CD4 cell count and adherence. The probability of no increase in CD4 cells was three times higher in patients with a baseline CD4 cell count of ≥200/mm(3) and 0.15 times lower with adherent patients. At 18 months, CD4 cell response was also significantly influenced by both baseline CD4 cell count and adherence. The probability of no increase in CD4 cells was 5.1 times higher in patients with a baseline CD4 cell count of ≥200/mm(3) and 0.28 times lower with adherent patients. At 24 months, optimal CD4 cell response was significantly influenced by adherence alone. Adherence increased the probability (by 5.8) of an optimal increase in CD4 cells. Age and baseline clinical state had no significant influence on immunological response.
  
  
  CONCLUSIONS
  The relationship between adherence and CD4 cell response was the most significant compared to that of baseline CD4 cell count. Counseling before initiation of treatment and educational therapy during follow-up must always help to strengthen adherence and optimize the efficiency of antiretroviral therapy in a resource-limited setting.
authors.affiliation: Laboratoire de Pharmacie Clinique, Pharmacologie et Therapeutique - UFR Sciences Pharmaceutiques et Biologiques, CHU de Cocody.
authors.forename: Danho Pascal
authors.initials: DP
authors.lastname: Abrogoua
authors.forename: Brou Jerome
authors.initials: BJ
authors.lastname: Kablan
authors.forename: Boua Alexis Thierry
authors.initials: BA
authors.lastname: Kamenan
authors.forename: Gilles
authors.initials: G
authors.lastname: Aulagner
authors.forename: Konan
authors.initials: K
authors.lastname: N'guessan
authors.forename: Christian
authors.initials: C
authors.lastname: Zohoré