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Publication Details
AFRICAN RESEARCH NEXUS
SHINING A SPOTLIGHT ON AFRICAN RESEARCH
medicine
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
BMC Infectious Diseases, Volume 14, No. 1, Article 153, Year 2014
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Description
Background: Aim 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.Methods: A 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.Results: A 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).Conclusions: Adherence 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. © 2014 Focà et al.; licensee BioMed Central Ltd.
Authors & Co-Authors
Focà, Emanuele
Italy, Brescia
Università Degli Studi Di Brescia
Italy, Brescia
Dipartimento Di Specialità Medico-chirurgiche, Scienze Radiologiche e Sanità Pubblica
Odolini, Silvia
Italy, Brescia
Università Degli Studi Di Brescia
Sulis, G.
Italy, Brescia
Università Degli Studi Di Brescia
Calza, S.
Italy, Brescia
Università Degli Studi Di Brescia
Pietra, Virginio
Burkina Faso
Saint Camille District Hospital
Rodari, Paola
Italy, Brescia
Università Degli Studi Di Brescia
Giorgetti, Pier Francesco
Italy, Brescia
Università Degli Studi Di Brescia
Noris, Alice
Italy, Brescia
Università Degli Studi Di Brescia
Ouédraogo, Paul
Burkina Faso, Ouagadougou
Centre Medical Saint Camille Cmsc
Simpore, J.
Burkina Faso, Ouagadougou
Centre de Recherche Biomoléculaire Pietro Annigoni
Pignatelli, Salvatore
Burkina Faso, Ouagadougou
Centre Medical Saint Camille Cmsc
Castelli, Francesco
Italy, Brescia
Università Degli Studi Di Brescia
Statistics
Citations: 20
Authors: 12
Affiliations: 5
Identifiers
Doi:
10.1186/1471-2334-14-153
e-ISSN:
14712334
Research Areas
Health System And Policy
Infectious Diseases
Study Design
Cohort Study
Study Locations
Multi-countries
Burkina Faso
Participants Gender
Female