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

BackgroundAim 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.MethodsA 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.ResultsA 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).ConclusionsAdherence 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.

Predictors of mortality among a cohort of HIV/AIDS patients on anti-retroviral therapy in coastal South India

“…Poor adherence leads to clinical failure, resulting in poor CD4 count, giving rise to OIs, and thereby increasing the risk of mortality. Various studies conducted across the globe have reported that poor adherence to ART increases mortality [15,28,29]. The results from our study as well as from similar studies across the world have pointed towards a variety of factors which predict mortality among PLHIV.…”

Predictors of poor retention on antiretroviral therapy as a major HIV drug resistance early warning indicator in Cameroon: results from a nationwide systematic random sampling

“…<75%) for patient retention on ART, translated into 40% potential lost to follow-up [12]. As loss to follow-up are known as possible HIVDR, national ART programs in SA has ~40% likelihood of experiencing HIVDR emergence in a short-medium run [10, 11]. Of note, only 10.71% ART clinics and only one region (Littoral) had acceptable performances (excellent or fair), suggesting that ~90% of ART clinics as well as 90% of regions are experiencing high risks of HIVDR due to poor retention on ART, similar to findings from other SSA-settings [13].…”

“…Retaining patients on lifelong ART, is an essential component in HIVDR prevention through adherence promotion, considerably improved the clinical and immunological outcomes [10, 11], reduced lost to follow-up and prolong the life expectancy of treated-patients [3]. As this indicator remains with uncertainty [7–9], it became crucial for the national AIDS programme to delineate the country performance in patient retention on ART as well as related determinants.…”

Impact of variability in adherence to HIV antiretroviral therapy on the immunovirological response and mortality

“…Another part of the present results confirm those of Palella et al [ 3 ], Nachega et al [ 7 ], and Abaasa et al [ 8 ] regarding the link between the average adherence and patient survival. Moreover, in a recent study conducted in Burkina Faso [ 25 ], the authors expressed adherence with a score (ranging from 0 to 10 points) and considered it in a Cox model as a time-varying covariate to point out that the less adherent patients had a higher risk of death. By classifying adherence into two categories (optimal: 8–10 points and sub-optimal: 0–7 points), the authors showed also that patients with optimal adherence had the best CD4-cell-count recovery.…”