@article{PAR00010209,
  title = {{A}dherence to and effectiveness of highly active antiretroviral treatment for {HIV} infection assessing the bidirectional relationship},
  author = {{L}amiraud, {K}. and {M}oatti, {J}ean-{P}aul and {R}affi, {F}. and {C}arrieri, {M}. {P}. and {P}rotopopescu, {C}. and {M}ichelet, {C}. and {S}chneider, {L}. and {C}ollin, {F}. and {L}eport, {C}. and {S}pire, {B}.},
  editor = {},
  language = {{ENG}},
  abstract = {{B}ackground: {I}t is well established that high adherence to {HIV}-infected patients on highly active antiretroviral treatment ({HAART}) is a major determinant of virological and immunologic success. {F}urthermore, psychosocial research has identified a wide range of adherence factors including patients' subjective beliefs about the effectiveness of {HAART}. {C}urrent statistical approaches, mainly based on the separate identification either of factors associated with treatment effectiveness or of those associated with adherence, fail to properly explore the true relationship between adherence and treatment effectiveness. {A}dherence behavior may be influenced not only by perceived benefits-which are usually the focus of related studies-but also by objective treatment benefits reflected in biological outcomes. {M}ethods: {O}ur objective was to assess the bidirectional relationship between adherence and response to treatment among patients enrolled in the {ANRS} {CO}8 {APROCO}-{COPILOTE} study. {W}e compared a conventional statistical approach based on the separate estimations of an adherence and an effectiveness equation to an econometric approach using a 2-equation simultaneous system based on the same 2 equations. {R}esults: {O}ur results highlight a reciprocal relationship between adherence and treatment effectiveness. {A}fter controlling for endogeneity, adherence was positively associated with treatment effectiveness. {F}urthermore, {CD}4 count gain after baseline was found to have a positive significant effect on adherence at each observation period. {T}his immunologic parameter was not significant when the adherence equation was estimated separately. {I}n the 2-equation model, the covariances between disturbances of both equations were found to be significant, thus confirming the statistical appropriacy of studying adherence and treatment effectiveness jointly. {C}onclusions: {O}ur results, which suggest that positive biological results arising as a result of high adherence levels, in turn reinforce continued adherence and strengthen the argument that patients who do not experience rapid improvement in their immunologic and clinical statuses after {HAART} initiation should be prioritized when developing adherence support interventions. {F}urthermore, they invalidate the hypothesis that {HAART} leads to "false reassurance" among {HIV}-infected patients.},
  keywords = {adherence ; {HIV} ; relationship between adherence and effectiveness ; simultaneous equations ; {GEE}},
  booktitle = {},
  journal = {{M}edical {C}are},
  volume = {50},
  numero = {5},
  pages = {410--418},
  ISSN = {0025-7079},
  year = {2012},
  DOI = {10.1097/{MLR}.0b013e3182422f61},
  URL = {https://www.documentation.ird.fr/hor/{PAR}00010209},
}