Effect of patient adherence to antiretroviral therapy on CD4+cell count, HIV-1 RNA, and serum concentrations of tumor necrosis factor and its solublereceptors

A 1-year prospective analysis of patient adherence to antiretroviral therap y (zidovudine plus zalcitabine [55 patients] or zidovudine plus zalcitabine plus saquinavir [32 patients]) was performed in human immunodeficiency vir us (HIV)infected patients attended at a tertiary care hospital. Adherence t o therapy was measured jointly by pharmacy records, patients' self-recordin g, and an increase in mean corpuscular volume. Likewise, the effects of the rapy on clinical parameters, HIV load, CD4+ cell count, and serum levels of tumor necrosis factor alpha (TNF alpha) and its soluble receptors were ana lyzed. Twenty-seven patients of those on a double-agent regimen and 12 of t hose on a triple-agent regimen adhered to the treatment, Ten opportunistic events occurred in noncompliant patients versus none in compliant individua ls, A significant increase in CD4+ cell count and a decrease in HIV viral l oad were observed only in patients who adhered to therapy, TNF and its solu ble receptors remained elevated at the end of follow-up, even in patients i n whom the HIV viral load decreased to < 400 copies/ml. In conclusion, adhe rence to therapy must be considered a major factor influencing the results of antiretroviral therapy. Although these treatments have been demonstrated to be efficacious, they are not able to normalize the immune activation ma rkers. These data suggest a suboptimal effect of antiretroviral therapy on the eradication of HIV-1.