@article{fdi:010063946,
  title = {{I}mpact of variability in adherence to {HIV} antiretroviral therapy on the immunovirological response and mortality},
  author = {{B}oussari, {O}. and {S}ubtil, {F}. and {G}enolini, {C}. and {B}astard, {M}. and {I}waz, {J}. and {F}onton, {N}. and {E}tard, {J}ean-{F}ran{\c{c}}ois and {E}cochard, {R}.},
  editor = {},
  language = {{ENG}},
  abstract = {{B}ackground: {S}everal previous studies have shown relationships between adherence to {HIV} antiretroviral therapy ({ART}) and the viral load, the {CD}4 cell count, or mortality. {H}owever, the impact of variability in adherence to {ART} on the immunovirological response does not seem to have been investigated yet. {M}ethods: {M}onthly adherence data ({N}ovember 1999 to {A}pril 2009) from 317 {HIV}-1 infected patients enrolled in the {S}enegalese {ART} initiative were analyzed. {L}atent-class trajectory models were used to build typical trajectories for the average adherence and the standardized variance of adherence. {T}he relationship between the standardized variance of adherence and each of the change in {CD}4 cell count, the change in viral load, and mortality were investigated using, respectively, a mixed linear regression, a mixed logistic regression, and a {C}ox model with time-dependent covariates. {A}ll the models were adjusted on the average adherence. {R}esults: {T}hree latent trajectories for the average adherence and three for the standardized variance of adherence were identified. {T}he increase in {CD}4 cell count and the increase in the percentage of undetectable viral loads were negatively associated with the standardized variance of adherence but positively associated with the average adherence. {T}he risk of death decreased significantly with the increase in the average adherence but increased significantly with the increase of the standardized variance of adherence. {C}onclusions: {T}he impacts of the level and the variability of adherence on the immunovirological response and survival justify the inclusion of these aspects into the process of patient education: adherence should be both high and constant.},
  keywords = {{L}atent trajectory modeling ; {C}lassification ; {P}atient adherence ; {H}ighly active antiretroviral therapy ; {SENEGAL}},
  booktitle = {},
  journal = {{BMC} {M}edical {R}esearch {M}ethodology},
  volume = {15},
  numero = {},
  pages = {art. 10 [8 p.]},
  ISSN = {1471-2288},
  year = {2015},
  DOI = {10.1186/1471-2288-15-10},
  URL = {https://www.documentation.ird.fr/hor/fdi:010063946},
}