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Adherence to and effectiveness of highly active antiretroviral treatment for HIV infection: assessing the bidirectional relationship.
Auteur(s) : Lamiraud, Karine Moatti, Jean-Paul Raffi, François Carrieri, Maria-Patrizia Protopopescu, Camelia Michelet, Christian Schneider, Luminita Collin, Fideline
Auteurs secondaires : Théorie économique, modélisation et applications (THEMA) ; Université de Cergy Pontoise - Centre National de la Recherche Scientifique (CNRS) ESSEC Business School ; Essec Business School Sciences Economiques et Sociales de la Santé & Traitement de l'Information Médicale (SESSTIM) ; Institut de Recherche pour le Développement (IRD) - Aix Marseille Université (AMU) - ORS PACA - Institut National de la Santé et de la Recherche Médicale (INSERM) ORS PACA Aix Marseille Université (AMU) Maladies infectieuses et tropicales Institut de recherche, santé, environnement et travail [Rennes] (Irset) ; Université d'Angers (UA) - Université des Antilles et de la Guyane (UAG) - Université de Rennes 1 (UR1) - École des Hautes Études en Santé Publique [EHESP] (EHESP) - Institut National de la Santé et de la Recherche Médicale (INSERM) - Structure Fédérative de Recherche en Biologie et Santé de Rennes ( Biosit : Biologie - Santé - Innovation Technologique ) Service des maladies infectieuses et tropicales [CHU Pitié-Salpêtrière] ; Assistance publique - Hôpitaux de Paris (AP-HP) - CHU Pitié-Salpêtrière [APHP]

Éditeur(s) : HAL CCSD American Public Health Association
Résumé : International audience
BACKGROUND: It 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. Furthermore, psychosocial research has identified a wide range of adherence factors including patients' subjective beliefs about the effectiveness of HAART. Current 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. Adherence 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. METHODS: Our objective was to assess the bidirectional relationship between adherence and response to treatment among patients enrolled in the ANRS CO8 APROCO-COPILOTE study. We 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. RESULTS: Our results highlight a reciprocal relationship between adherence and treatment effectiveness. After controlling for endogeneity, adherence was positively associated with treatment effectiveness. Furthermore, CD4 count gain after baseline was found to have a positive significant effect on adherence at each observation period. This immunologic parameter was not significant when the adherence equation was estimated separately. In 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. CONCLUSIONS: Our 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. Furthermore, they invalidate the hypothesis that HAART leads to "false reassurance" among HIV-infected patients.
ISSN: 0025-7079

hal-00875196
https://hal.archives-ouvertes.fr/hal-00875196
DOI : 10.1097/MLR.0b013e3182422f61
PUBMED : 22362167

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