title: Impact of variability in adherence to HIV antiretroviral therapy on the immunovirological response and mortality.
abstract: BACKGROUND
  Several previous studies have shown relationships between adherence to HIV antiretroviral therapy (ART) and the viral load, the CD4 cell count, or mortality. However, the impact of variability in adherence to ART on the immunovirological response does not seem to have been investigated yet.
  
  
  METHODS
  Monthly adherence data (November 1999 to April 2009) from 317 HIV-1 infected patients enrolled in the Senegalese ART initiative were analyzed. Latent-class trajectory models were used to build typical trajectories for the average adherence and the standardized variance of adherence. The relationship between the standardized variance of adherence and each of the change in CD4 cell count, the change in viral load, and mortality were investigated using, respectively, a mixed linear regression, a mixed logistic regression, and a Cox model with time-dependent covariates. All the models were adjusted on the average adherence.
  
  
  RESULTS
  Three latent trajectories for the average adherence and three for the standardized variance of adherence were identified. The increase in CD4 cell count and the increase in the percentage of undetectable viral loads were negatively associated with the standardized variance of adherence but positively associated with the average adherence. The risk of death decreased significantly with the increase in the average adherence but increased significantly with the increase of the standardized variance of adherence.
  
  
  CONCLUSIONS
  The impacts of the level and the variability of adherence on the immunovirological response and survival justify the inclusion of these aspects into the process of patient education: adherence should be both high and constant.
authors: Mathematical Physics and Applications, Laboratoire d'Etude et de Recherche en Statistique Appliquée et Modélisation, Université d'Abomey-Calavi, Abomey-Calavi, Bénin. olayideb@yahoo.fr.|Hospices Civils de Lyon, Service de Biostatistique, F-69003, Lyon, France. olayideb@yahoo.fr.|Université de Lyon, F-69000, Lyon, France. olayideb@yahoo.fr.|Université Lyon 1, F-69100, Villeurbanne, France. olayideb@yahoo.fr.|CNRS, UMR5558, Laboratoire de Biométrie et Biologie Evolutive, Equipe Biostatistique-Santé, F-69100, Villeurbanne, France. olayideb@yahoo.fr.
authors: Olayidé
authors: O
authors: Boussari
authors: Hospices Civils de Lyon, Service de Biostatistique, F-69003, Lyon, France. fabien.subtil@chu-lyon.fr.|Université de Lyon, F-69000, Lyon, France. fabien.subtil@chu-lyon.fr.|Université Lyon 1, F-69100, Villeurbanne, France. fabien.subtil@chu-lyon.fr.|CNRS, UMR5558, Laboratoire de Biométrie et Biologie Evolutive, Equipe Biostatistique-Santé, F-69100, Villeurbanne, France. fabien.subtil@chu-lyon.fr.
authors: Fabien
authors: F
authors: Subtil
authors: INSERM, UMR 1027, Research Unit on Perinatal Epidemiology and Childhood Disabilities, Adolescent Health, F-31062, Toulouse, France. christophe.genolini@u-paris10.fr.|CeRSM (EA 2931), UFR STAPS, Université Paris Ouest Nanterre La Défense, F-92001, Nanterre, France. christophe.genolini@u-paris10.fr.
authors: Christophe
authors: C
authors: Genolini
authors: Epicentre, F-75012, Paris, France. mathieu.bastard@geneva.msf.org.
authors: Mathieu
authors: M
authors: Bastard
authors: Hospices Civils de Lyon, Service de Biostatistique, F-69003, Lyon, France. jean.iwaz@chu-lyon.fr.|Université de Lyon, F-69000, Lyon, France. jean.iwaz@chu-lyon.fr.|Université Lyon 1, F-69100, Villeurbanne, France. jean.iwaz@chu-lyon.fr.|CNRS, UMR5558, Laboratoire de Biométrie et Biologie Evolutive, Equipe Biostatistique-Santé, F-69100, Villeurbanne, France. jean.iwaz@chu-lyon.fr.
authors: Jean
authors: J
authors: Iwaz
authors: Mathematical Physics and Applications, Laboratoire d'Etude et de Recherche en Statistique Appliquée et Modélisation, Université d'Abomey-Calavi, Abomey-Calavi, Bénin. hnfonton@gmail.com.
authors: Noël
authors: N
authors: Fonton
authors: UMI 233 TransVIHMI, Institut de Recherche pour le Développement, Université Montpellier 1, F-34394, Montpellier, France. jean-francois.etard@ird.fr.
authors: Jean-François
authors: JF
authors: Etard
authors: Hospices Civils de Lyon, Service de Biostatistique, F-69003, Lyon, France. rene.ecochard@chu-lyon.fr.|Université de Lyon, F-69000, Lyon, France. rene.ecochard@chu-lyon.fr.|Université Lyon 1, F-69100, Villeurbanne, France. rene.ecochard@chu-lyon.fr.|CNRS, UMR5558, Laboratoire de Biométrie et Biologie Evolutive, Equipe Biostatistique-Santé, F-69100, Villeurbanne, France. rene.ecochard@chu-lyon.fr.
authors: René
authors: R
authors: Ecochard
mesh_terms: D000328:Adult; D019380:Anti-HIV Agents / Q000600:supply & distribution* / Q000627:therapeutic use; D023241:Antiretroviral Therapy, Highly Active; D018791:CD4 Lymphocyte Count; D005260:Female; D006078:Government Programs / Q000379:methods / Q000706:statistics & numerical data; D015658:HIV Infections / Q000188:drug therapy* / Q000276:immunology / Q000821:virology; D006801:Humans; D016014:Linear Models; D016015:Logistic Models; D008297:Male; D017063:Outcome Assessment, Health Care / Q000379:methods / Q000706:statistics & numerical data; D016016:Proportional Hazards Models; D012675:Senegal; D016019:Survival Analysis; D013997:Time Factors; D019562:Viral Load / Q000187:drug effects; D016903:Drug Monitoring
chemical_list: D019380:Anti-HIV Agents
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