Adherence to antiretroviral treatments with a protease inhibitor in HIV-infected patients

Objective. -Long-term therapeutic success of powerful antiretroviral treatm ents dependent on patient adherence. This study was conducted to assess the difficulties HIV-infected patients with advanced-stage disease encounter i n adhering to antiretroviral treatments with a protease inhibitor. Patients and methods. -A prospective self-administered questionnaire survey was conducted at our outpatient clinic for 2 months. CD4 counts and HIV vi ral loads were also determined. Results. -Seventy-one percent of the study population which included 262 re sponded to the questionnaire. The survey was made a median 215 days after i nitiating the antiprotease treatment with indinavir (71% of the cases), rit onavir (13%), saquinavir (6%), or a combination of protease inhibitors (10% ), At onset of antiprotease treatment, mean CD4 count was 171+/-150/mm(3) a nd mean HIV viral load was 75,000 copies/ml. The treatment was considered to be difficult to take by 43% of the patients ; 66% stated they had forgotten to take their drugs at least once a month. It was most difficult to take the drugs prescribed for the afternoon. Shift s of greater than or equal to 1 hour were observed in 58% of patients. Non- adherence was frequent (greater than or equal to 1 failure to take drugs pe r week), observed in 13% of patients. Most often, the patients stated they had forgotten to take their drugs because of occupational or relational dif ficulties (52%). Non-adherence increased with duration of treatment. The dr ug most often associated with non-adherence was indinavir (73%). Age and sex did not influence adherence. Mean RNA HIV serum Level was lower than at onset of the antiprotease treatment in the most non-adherent patie nts. At the time of the questionnaire, there was no difference in serum RNA HIV level or in the percentage of patients with an undetectable level betw een nonadherent and adherent patients.