The dynamic of adherence to highly active antiretroviral therapy: Results from the French National APROCO cohort

Objectives: Our objective was to describe the evolution of adherence to hig hly active antiretroviral therapy (HAART) over a 20-month period and its re lationship with virologic success. Methods: Self-reported adherence, clinical, and virologic data Were collect ed 4 (M4), 12 (M12), and 20 (M20) months after initiation of a protease inh ibitor-containing regimen in the French APROCO cohort. At each visit, patie nts were classified as nonadherent, moderately, or highly adherent, and HIV plasma RNA was determined. Results: Among the 762 patients who were regularly followed until M20, the 436 patients who answered to all questionnaires, including adherence measur ement, were selected for the analysis. The proportion of highly adherent pa tients was 55.7%, 62.2%, and 60.3% at M4, M12, and M20, respectively. A tot al of 137 patients (31.4%) was "always," 225 (51.6%) "sometimes," and 74 (1 7.0%) "never" "highly adherent" during follow-up. After multiple adjustment for known baseline predictors, virologic success after 20 months of HAART was more likely achieved in patients who were always (odds ratio [OR] 95% c onfidence interval [CI], 3.02 [1.64-5.58]) or sometimes (OR [95% Cl], 2.15 [1.24-3.74]) "highly adherent." Conclusion: Adherence behavior is a dynamic process. Continued adherence wa s associated with better response to therapy and should be encouraged to re duce the risk of virologic failure.