Impact of adherence to antiretroviral therapy in HIV-1-infected patients at a university public service in Brazil

The objective of this study was to assess if a simple evaluation, adherence to antiretroviral therapy, would correlate to clinical and laboratory outc omes. We followed an open cohort of patients from a public teaching hospita l AIDS outpatient clinic. Patients were categorized according to adherence as: regular (Reg), optimal, all doses all days, tolerating only irregular t iming (+/-2 hours) of intake; quasi-regular (qReg), those missing up to fou r doses or 1 full day during a month; irregular (Irreg), all other irregula r regimens, and ignored (Ign), those without information. The results from a simple questionnaire were compared to CD4(+) cell counts and human immuno deficiency virus type 1 (HIV-1) RNA plasma viremia. One hundred eighty-two HIV-1-infected patients (126 males, 69%; 56 females, 31%) were analyzed. In formation on adherence was available for 168 (90%). Reg adherence was repor ted by 75 (41%) patients, qReg adherence by 35 (19%), and Irreg by 53 (29%) of patients. The main reasons for nonadherence were forgetfulness, intoler ance, use of alcohol, and misunderstanding of prescription. A significant i ncrease of CD4+ T-cell counts and absolute gain were only observed among Re g and qReg users (p<0.001). The median viral RNA load log(10) decreases wer e -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 almos t exclusively among those with Ign or Irreg adherence. Previous use of anti retroviral therapy may have had an impact in treatment response. Individual s who were treatment-naive were more likely to be Reg users (41%). Although more refined methods to assess adherence should be implemented when availa ble, the inability to do so should not prevent simple, albeit subjective me asurements that also correlate with favorable outcome. Mechanisms to improv e adherence should be considered an integral part of antiretroviral therapy .