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Clinical and immunological outcomes according to adherence to first-line HAART in a urban and rural cohort of HIV-infected patients in Burkina Faso, West Africa

Authors
  • Focà, Emanuele1, 2
  • Odolini, Silvia1
  • Sulis, Giorgia1
  • Calza, Stefano3
  • Pietra, Virginio4, 5
  • Rodari, Paola1
  • Giorgetti, Pier Francesco1
  • Noris, Alice1
  • Ouedraogo, Paul6
  • Simpore, Jacques7
  • Pignatelli, Salvatore4, 6
  • Castelli, Francesco1, 4
  • 1 University of Brescia, University Division of Infectious and Tropical Diseases, Brescia, Italy , Brescia (Italy)
  • 2 University of Brescia, School of Medicine, P.le Spedali Civili, University Division of Infectious and Tropical Diseases, Brescia, 1-25123, Italy , Brescia (Italy)
  • 3 University of Brescia, Unit of Biostatistics and Biomatemathics, Department of Molecular and Translational Medicine, Brescia, Italy , Brescia (Italy)
  • 4 Medicus Mundi Italy NGO, Brescia, Italy , Brescia (Italy)
  • 5 Saint Camille District Hospital, Nanoro, Burkina Faso , Nanoro (Burkina Faso)
  • 6 Centre Medicale Saint Camille (CMSC), Ouagadougou, Burkina Faso , Ouagadougou (Burkina Faso)
  • 7 Centre de Recherché Biomoleculaire Pietro Annigoni, Ouagadougou, Burkina Faso , Ouagadougou (Burkina Faso)
Type
Published Article
Journal
BMC Infectious Diseases
Publisher
Springer (Biomed Central Ltd.)
Publication Date
Mar 21, 2014
Volume
14
Issue
1
Identifiers
DOI: 10.1186/1471-2334-14-153
Source
Springer Nature
Keywords
License
Green

Abstract

BackgroundAim of our study is to investigate the clinical and immunological outcomes according to first-line HAART adherence in a large cohort of HIV-infected patients in Burkina Faso.MethodsA retrospective study was conducted between 2001 and 2009 among patients from two urban medical centers [St. Camille Medical Center (CMSC) and “Pietro Annigoni” Biomolecular Research Center (CERBA)] and 1 in the rural District of Nanoro (St. Camille District Hospital). Socio-demographical and clinical data were analyzed. Adherence was evaluated through a questionnaire investigating 5 key points related to drugs, consultations and blood exams, by assigning 0 to 2 points each up to 10 points overall. Data were collected at baseline and regularly thereafter. Adherence score was considered as a continuous variable and classified in optimal (8–10 points) and sub-optimal (0–7 points). Immunological outcome was evaluated as modification in CD4+ T-cell count over time, while predictors of death were explored by a univariate and multivariate Cox model considering adherence score as a time-varying covariate.ResultsA total of 625 patients were included: 455 (72.8%) were females, the median age was 33.3 (IQR 10.2) years, 204 (32.6.%) were illiterates, the median CD4+ T-cell count was 149 (IQR 114) cells/μl at baseline. At the end of the observation period we recorded 60/625 deaths and 40 lost to follow-up. The analysis of immunological outcomes showed a significant variation in CD4+ T-cell count between M12 and M24 only for patients with optimal adherence (Δ=78.2, p<0.001), with a significant Δ between the two adherence groups at M24 (8–10 vs 0–7, Δ=53.8, p=0.004). Survival multivariate analysis revealed that covariates significantly related to death included being followed at CERBA (urban area) or Nanoro (rural area), and receiving a regimen not including fixed dose combinations, (p=0.024, p=0.001 and p<0.001 respectively); conversely, an increasing adherence score as well as an optimal adherence score were significantly related to survival (p<0.001).ConclusionsAdherence to HAART remains pivotal to build up a good therapeutic outcome. Our results confirm that, according to our adherence system evaluation, less adherent patients have a higher risk of death and of inadequate CD4+ count recovery.

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