title: Clinical and immunological outcomes according to adherence to first-line HAART in a urban and rural cohort of HIV-infected patients in Burkina Faso, West Africa.
abstract: BACKGROUND
  Aim of our study is to investigate the clinical and immunological outcomes according to first-line HAART adherence in a large cohort of HIV-infected patients in Burkina Faso.
  
  
  METHODS
  A retrospective study was conducted between 2001 and 2009 among patients from two urban medical centers [St. Camille Medical Center (CMSC) and "Pietro Annigoni" Biomolecular Research Center (CERBA)] and 1 in the rural District of Nanoro (St. Camille District Hospital). Socio-demographical and clinical data were analyzed. Adherence was evaluated through a questionnaire investigating 5 key points related to drugs, consultations and blood exams, by assigning 0 to 2 points each up to 10 points overall. Data were collected at baseline and regularly thereafter. Adherence score was considered as a continuous variable and classified in optimal (8-10 points) and sub-optimal (0-7 points). Immunological outcome was evaluated as modification in CD4+ T-cell count over time, while predictors of death were explored by a univariate and multivariate Cox model considering adherence score as a time-varying covariate.
  
  
  RESULTS
  A total of 625 patients were included: 455 (72.8%) were females, the median age was 33.3 (IQR 10.2) years, 204 (32.6.%) were illiterates, the median CD4+ T-cell count was 149 (IQR 114) cells/μl at baseline. At the end of the observation period we recorded 60/625 deaths and 40 lost to follow-up. The analysis of immunological outcomes showed a significant variation in CD4+ T-cell count between M12 and M24 only for patients with optimal adherence (Δ=78.2, p<0.001), with a significant Δ between the two adherence groups at M24 (8-10 vs 0-7, Δ=53.8, p=0.004). Survival multivariate analysis revealed that covariates significantly related to death included being followed at CERBA (urban area) or Nanoro (rural area), and receiving a regimen not including fixed dose combinations, (p=0.024, p=0.001 and p<0.001 respectively); conversely, an increasing adherence score as well as an optimal adherence score were significantly related to survival (p<0.001).
  
  
  CONCLUSIONS
  Adherence to HAART remains pivotal to build up a good therapeutic outcome. Our results confirm that, according to our adherence system evaluation, less adherent patients have a higher risk of death and of inadequate CD4+ count recovery.
authors.affiliation: University Division of Infectious and Tropical Diseases, University of Brescia, Brescia, Italy. emanuelefoca@gmail.com.
authors.forename: Emanuele
authors.initials: E
authors.lastname: Focà
authors.forename: Silvia
authors.initials: S
authors.lastname: Odolini
authors.forename: Giorgia
authors.initials: G
authors.lastname: Sulis
authors.forename: Stefano
authors.initials: S
authors.lastname: Calza
authors.forename: Virginio
authors.initials: V
authors.lastname: Pietra
authors.forename: Paola
authors.initials: P
authors.lastname: Rodari
authors.forename: Pier Francesco
authors.initials: PF
authors.lastname: Giorgetti
authors.forename: Alice
authors.initials: A
authors.lastname: Noris
authors.forename: Paul
authors.initials: P
authors.lastname: Ouedraogo
authors.forename: Jacques
authors.initials: J
authors.lastname: Simpore
authors.forename: Salvatore
authors.initials: S
authors.lastname: Pignatelli
authors.forename: Francesco
authors.initials: F
authors.lastname: Castelli
mesh_terms: D000328:Adult; D044966:Anti-Retroviral Agents / Q000008:administration & dosage*; D023241:Antiretroviral Therapy, Highly Active / Q000379:methods / Q000706:statistics & numerical data; D002050:Burkina Faso / Q000453:epidemiology; D018791:CD4 Lymphocyte Count; D015331:Cohort Studies; D005260:Female; D015658:HIV Infections / Q000188:drug therapy* / Q000453:epidemiology / Q000276:immunology; D006801:Humans; D008137:Longitudinal Studies; D008297:Male; D012189:Retrospective Studies; D012424:Rural Population; D014505:Urban Population; D055815:Young Adult; D016903:Drug Monitoring
chemical_list: D044966:Anti-Retroviral Agents