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Morphologic alterations in HIV-infected people with lipodystrophy are associated with good adherence to HAART
Giovanni Guaraldi1, Rita Murri, Gabriella Orlando
1Department of Medical and Surgery Specialities, infectious Diseases Clinic, University of Modena and Reggio Emilia School of Medicine, Italy. g.guaraldi@unimo.it
Insights
Adherence to highly active antiretroviral therapy (HAART) is linked to morphologic alterations (MOA) in HIV patients. Patients with MOA showed better adherence, but it decreased over time.
Area of Science:
- Infectious Diseases
- Virology
- Clinical Medicine
Background:
- Morphologic alterations (MOA) are a concern for patients on highly active antiretroviral therapy (HAART).
- Understanding factors associated with MOA, including drug adherence, is crucial for patient management.
Purpose of the Study:
- To investigate the relationship between drug adherence and morphologic alterations (MOA) in a cohort of HIV-infected patients receiving HAART.
Main Methods:
- A cross-sectional multicenter cohort study was conducted with 175 HIV-infected outpatients on HAART.
- Data were collected via self-administered questionnaires assessing MOA and drug adherence.
- MOA was defined using the Multicenter AIDS Cohort Study (MACS) criteria.
Main Results:
- Nearly half of the patients (47%) reported MOA, with 57% experiencing changes for over 12 months.
- Patients with MOA had significantly longer durations on HAART and higher odds of adherence.
- Older age, female gender, undetectable HIV RNA, and longer HAART duration were independently associated with MOA.
Conclusions:
- Longer duration on HAART and self-reported adherence correlate with the presence of MOA.
- MOA is also associated with patient demographics such as older age and female gender.
- Adherence may decline over extended periods of HAART treatment in patients with MOA.
Objective:
To evaluate the association between adherence to drugs and morphologic alterations (MOA) in a cohort of HIV-infected patients on HAART.
Method:
This was a cross-sectional multicenter cohort study in eight tertiary Clinical Centers of Northern and Central Italy. Consecutive outpatients taking HAART were enrolled from August 2000 to March 2001. They completed a self-administered questionnaire for the evaluation of signs of MOA and the self-reported adherence to drugs. Main outcome measures were MOA according to the Multicenter AIDS Cohort Study (MACS) definition and adherence to drugs.
Results:
One hundred seventy-five persons were enrolled into the study. Median CD4 cell count was 522 (interquartile range [IQR] 306-720); 35% of people had undetectable HIV RNA. Patients had been taking HAART for a median of 53 months (IQR 33-62). Among enrolled patients, 83 (47%) had a diagnosis of self-reported MOA; 57 of them reported body changes of more than 12 months duration. Forty persons (23%) self-reported nonadherence in the previous week. Mean time on HAART was 48.7 months (SD = 19.7) for people with MOA and 42.1 months (SD = 21.8) for those without MOA (p =.043). The odds of adherence for people with MOA was 2.36 times (95% CI 1.11-5.00) higher than for people without MOA. On multivariate analysis, being older and female, having an undetectable HIV RNA, longer duration on HAART, and self-reported adherence were independently associated with the presence of MOA. In people with MOA, adherence seems to decrease over time.
Conclusion:
Longer time on HAART and self-reported adherence were correlated to MOA. MOA was also associated with older age and female gender.