title: Factors associated with therapeutic success in HIV-positive individuals in southern Brazil.
abstract: OBJECTIVE
  Therapeutic success is characterized by undetectable viral load, immune reconstitution confirmed by CD4+ T-cell count and no clinical manifestations of disease. High treatment adherence is a major determinant of therapeutic success that needs prevention of viral replication, allowing immune reconstitution. Adherence to treatment <95% has been associated with both immune and viral failure. The objective of this study was to evaluate factors associated with therapeutic success in adult patients on highly active antiretroviral therapy (HAART) in a specialized centre for HIV-AIDS in southern Brazil, being defined therapeutic success as achieving and maintaining undetectable viral load, stable immune status (CD4+ T lymphocyte count ≥200 cells/mm(3) ) and adherence to HAART ≥ 95%.
  
  
  METHODS
  We conducted a historical cohort study nested in the PC-HIV randomized clinical trial of PC-HIV. We included adults who were on HAART at Pelotas HIV/AIDS Assistance Service between June 2006 and July 2007 and for whom information on treatment adherence, viral load and CD4+ cell count was available. Pregnant women were excluded. We obtained clinical data from medical records and socio-demographic information in an interview. Therapeutic success was defined as achieving and maintaining undetectable viral load, stable immune status (CD4+ T lymphocyte count ≥200 cells/mm(3) ) and adherence to HAART ≥95%.
  
  
  CONCLUSIONS
  We included 136 patients (60% male) in the cohort study. Mean age was 40 ± 10 years, and median treatment duration was 59 months (IQR 25-93). Family income varied from 0 to 8 times the minimum wage (IQR 1·0-2·3). Therapeutic success was achieved by 90% (122 patients), and it was associated with previously undetectable viral load (PR = 1·30; 95% CI = 1·13-1·49) and treatment adherence prior to study entry (PR = 1·34; 95% CI = 1·07-1·69), independently of sex, age and previous immune status.
  When undetectable viral load, CD4+ cell count ≥200 cells/mm(3) and treatment adherence above 95% are included in the definition of therapeutic success, the rate was elevated (90%) and the factors associated were previous history of adherence to HAART and previous undetectable viral load.
authors.affiliation: Departamento de Fisiologia e Farmacologia, Instituto de Biologia, Universidade Federal de Pelotas (UFPEL), Pelotas, RS, Brazil.
authors.forename: M P T
authors.initials: MP
authors.lastname: Silveira
authors.forename: P
authors.initials: P
authors.lastname: Maurer
authors.forename: M C
authors.initials: MC
authors.lastname: Guttier
authors.forename: L B
authors.initials: LB
authors.lastname: Moreira
mesh_terms: D000163:Acquired Immunodeficiency Syndrome / Q000188:drug therapy; D000293:Adolescent; D000328:Adult; D000367:Age Factors; D023241:Antiretroviral Therapy, Highly Active / Q000379:methods*; D001938:Brazil; D015496:CD4-Positive T-Lymphocytes; D005260:Female; D015658:HIV Infections / Q000188:drug therapy*; D015438:Health Behavior; D006801:Humans; D008297:Male; D008875:Middle Aged; D012737:Sex Factors; D012959:Socioeconomic Factors; D016896:Treatment Outcome; D019562:Viral Load; D055815:Young Adult; D016903:Drug Monitoring
keywords: clinical pharmacy; highly active antiretroviral therapy; medication; medication adherence; patient characteristics; pharmaceutical care; pharmacist consultation; pharmacists; pharmacy practice; treatment strategies