Marseille 2007
| Abstract #298 - High adherence and positive outcomes of HIV infected Patients at 24 Months of HAART in Cambodia | ||||
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Session: 24.1: Adherence (Parallel) on Monday @ 16.30-18.30 in HC Chaired by Ana Josefina Guell, Rahul Battcharya Authors: Presenting Author: Dr Bruno Spire - INSERM U379, France |
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| Additional Authors: Dr Mar Pujades, Dr Laurent Ferradini, Dr Didier Laureillard, Dr Narom Prak, Dr Chanchhaya Ngeth, Dr Marcelo Fernandez, Dr Gloria Puertas, Dr Anne-Marie Taburet, Dr Nary Ly, Dr Chea You Sreng, Dr Eric Nerrienet, Dr Suna Balkan, Dr Catherine Quillet, Prof Jean-Franois Delfraissy, | ||||
| Aim: Prospective studies in Africa and Asia have demonstrated the feasibility and efficacy of highly active antiretroviral therapy (HAART) in resource-poor settings and the importance of adherence to achieve this goal. However, long-term virological suppression and clinico-immunological criteria of success remain important questions. In this study, we report the results from a patient adherence evaluation performed 24 months after HAART initiation for patients treated by Mdecins Sans Frontires/Ministry of Health in Cambodia | ||||
| Method / Issue: Adults initiated on HAART 24+2 months before the study were included. Socio-demographic and medical data were collected using FUCHIA software (Epicentre, Paris, France). Adherence was measured using a face-to face questionnaire. Adherence scores were computed using patients replies to 7 questions about HAART compliance in the prior 4 weeks. The questionnaire also includes reported HAART-related side-effects, and 10 questions about HIV disclosure in the social network (e.g. steady partner) and relationship with health staff. HIV-1 RNA plasmatic viral load was assessed by real-time PCR and virological success defined as <40 copies/ml. Fisherexact tests allowed assessing the association between adherence and virological success. Poisson regression models were used to study the independent effect of factors associated with non-adherence to HAART. | ||||
| Results / Comments: 346 patients participated in the survey. Their median age was 36 years (IQR 32-40) and 57.5% were males. 95.4% were ARV nave and 62.4% (n=216) had a CD4 count <50 cells/l at HAART initiation. At M24, 79.8% had a HIVRNA below 40 cp/ml and 74.9% CD4 counts >200. The proportion of adherent patients at M24 was 95.4%. The proportion of patients with virological success was significantly higher in the adherent patients than in non-adherent patients (81% vs. 44 %, p=0.03). Non-adherent patients were more likely to be unmarried (p=0.02) and to report side-effects (p=0.02), including modification of body shape (p=0.02). They disclosed their HIV status less frequently to their steady partner (p=0.03) or to their child p=0.14). Independent factors associated with non-adherence were to be unmarried (IR[95%CI]= 1.07[1.01-1.12]), not to have disclosed HIV status to his/her child (IR[95%CI]= 1.04[1-1.09]), and to report a modification of body shape (IR[95%CI] = 1.06[1.01-1.12]). | ||||
| Discussion: At M24, adherence to treatment was high and explained the good virological outcomes. Special attention is however needed to patients who complain about their morphological aspect or to those who express difficulties with disclosure to their close family in order to maintain high adherence and long-term virological benefits. | ||||
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