Impact of Adherence to Antiretroviral Therapy in HIV-1–Infected Patients at a University Public Service in Brazil

Abstract

The objective of this study was to assess if a simple evaluation, adherence to antiretroviral therapy, would correlate to clinical and laboratory outcomes. We followed an open cohort of patients from a public teaching hospital AIDS outpatient clinic. Patients were categorized according to adherence as: regular (Reg), optimal, all doses all days, tolerating only irregular timing (+/- 2 hours) of intake; quasi-regular (qReg), those missing up to four doses or 1 full day during a month; irregular (Irreg), all other irregular regimens, and ignored (Ign), those without information. The results from a simple questionnaire were compared to CD4+ cell counts and human immunodeficiency virus type 1 (HIV-1) RNA plasma viremia. One hundred eighty-two HIV-1-infected patients (126 males, 69%; 56 females, 31%) were analyzed. Information on adherence was available for 168 (90%). Reg adherence was reported by 75 (41%) patients, qReg adherence by 35 (19%), and Irreg by 53 (29%) of patients. The main reasons for nonadherence were forgetfulness, intolerance, use of alcohol, and misunderstanding of prescription. A significant increase of CD4+ T-cell counts and absolute gain were only observed among Reg and qReg users (p < 0.001). The median viral RNA load log10 decreases were -1.68, -1.45, -0.9 log, respectively, for Reg, qReg, and Irreg patients (p = 0.043, Kruskal-Wallis). Development of and death from AIDS occurred almost exclusively among those with Ign or Irreg adherence. Previous use of antiretroviral therapy may have had an impact in treatment response. Individuals who were treatment-naive were more likely to be Reg users (41%). Although more refined methods to assess adherence should be implemented when available, the inability to do so should not prevent simple, albeit subjective measurements that also correlate with favorable outcome. Mechanisms to improve adherence should be considered an integral part of antiretroviral therapy.

The first ten years: achievements and challenges of the Brazilian program of universal access to HIV/AIDS comprehensive management and care, 1996-2006

“…"Regular" adherence was reported by 41% patients, "quasi-regular adherence" was reported by 19%, and "irregular" adherence was reported by the remaining 29%. Irregular adherence was independently associated with forgetfulness, intolerance, alcohol consumption, and misunderstanding of prescriptions 27 .…”

“…25 . Such discrepancies in terms of what is being measured and how it is being measured may explain the variation observed, with a range of 52 to 83% of patients considered "adherent" to ARV therapy 26,27,28,29,30,31,32,33,34,35,36,37 .…”

Estimating the impact of alcohol consumption on survival for HIV+ individuals

“…Alcohol consumption is the most prevalent risk factor for poor adherence to Highly Active Antiretroviral Therapy (HAART) among HIV-positive (HIV+) individuals, with approximately half of all persons reporting recent use (Golin et al, 2002;Chesney et al, 2000) While the cross-sectional association is well established (Paterson et al 2000, d'Arminio et al 2005Howard et al 2002;Brigido et al 2001;Haubrich et al 1999), recently it has been shown that there is a tightly coupled temporal association, with nonadherence on drinking days greatly exceeding nonadherence on nondrinking days in a particular patient sample (Braithwaite et al 2005a). This observation decreases the likelihood that the relationship between alcohol consumption and antiretroviral nonadherence is spurious and merely attributable to confounding.…”

Human immunodeficiency virus type 1 Brazilian subtype B variant showed an increasing avidity of the anti-V3 antibodies over time compared to the subtype B US/European strain in São Paulo, Brazil

“…This cohort has been followed up in the Ambulatory of the Secondary Immunodeficiency Clinic, Department of Dermatology of the Hospital das Clínicas, School of Medicine of the São Paulo University. More details regarding this cohort have been published elsewhere (Fonseca et al 1999, Brigido et al 2001). The statistical analysis was done using a nonparametric test (Mann-Whitney's test) to compare the groups, and the results presented in mean and standard deviation values, obtained with samples collected at the last available point (year 2000).…”