Adherence to antiretroviral therapy and its determinants among persons living with HIV/AIDS in Bayelsa state, Nigeria

Background: A high level of adherence is required to achieve the desired outcomes of antiretroviral therapy. There is paucity of information about adherence to combined antiretroviral therapy in Bayelsa State of southern Nigeria. Objectives: The objectives of the study were to determine the level of adherence to combined antiretroviral therapy among the patients, evaluate the improvement in their immune status and identify reasons for sub-optimal adherence to therapy. Methods: The cross-sectional study involved administration of an adapted and pretested questionnaire to 601 consented patients attending the two tertiary health institutions in Bayesla State, Nigeria: The Federal Medical Centre, Yenagoa and the Niger-Delta University Teaching Hospital Okolobiri. The tool was divided into various sections such as socio-demographic data, HIV knowledge and adherence to combined antiretroviral therapy. Information on the patient's CD4+ T cells count was retrieved from their medical records. Adherence was assessed by asking patients to recall their intake of prescribed doses in the last fourteen days and subjects who had 95-100% of the prescribed antiretroviral drugs were considered adherent. Results: Three hundred and forty eight (57.9%) of the subjects were females and 253 (42.1%) were males. The majority of them, 557 (92.7%) have good knowledge of HIV and combined anti-retroviral therapy with a score of 70.0% and above. A larger proportion of the respondents, 441 (73.4%), had > 95% adherence. Some of the most important reasons giving for missing doses include, “simply forgot” 147 (24.5%), and “wanted to avoid the side-effects of drugs” 33(5.5%). There were remarkable improvements in the immune status of the subjects with an increment in the proportion of the subjects with CD4+ T cells count of greater than 350 cells/mm3 from 33 (5.5%) at therapy initiation to 338 (56.3%) at study period (p<0.0001). Conclusion: The adherence level of 73.4% was low which calls for intervention and improvement. The combined antiretroviral therapy has significantly improved the immune status of the majority of patients which must be sustained. “Simply forgot” was the most important reason for missing doses.

The most significant deficiencies in macro and micro nutrients in adolescents living with HIV/AIDS in antiretroviral therapy

Objective: To evaluate macro and micronutrients intake of adolescents living with HIV/AIDS in use of antiretroviral therapy and compare it to the Dietary Reference Intakes. Methodology: Cross-sectional study conducted with adolescents of both genders with HIV/AIDS, assessing the dietary composition of macro and micronutrients, using the 24h dietary recall. Results: 39 adolescents, average age of 15 years, 51.3% males. The participants intake of total calories, total fiber (g/d), liposoluble vitamins (A, D, E, K), vitamin B5 (mg/d), vitamin B9 (mg/d), vitamin C (mg/d), calcium (mg/d), phosphorus (mg/d), potassium (mg/d), and magnesium (mg/d) was lower than recommended. The percentages of intake lower than recommended were 79.5% for calories, 82.1% for total fibers, 89.7% for vitamin A, 100% for vitamin D, 87.2% for vitamin E, 100% for vitamin K, 71.8% for vitamin B5, 82.1% for vitamin B9, 76.9% for vitamin C, 92.3% for calcium, 61.5% for phosphorus, 97.4% for potassium, and 76.9% for magnesium. The participants ingested more carbohydrates (g), proteins (g), vitamins B2 (mg/d), B3 (mg/d), B8 (mg/d) and sodium (g/d) than recommended, the percentages above the recommendations being 92.3% for carbohydrates, 64.1% for proteins and vitamin B2, 56.4% for vitamin B3, 82.1% for vitamin B8, and 59% for sodium. The remaining nutrients were within the amounts recommended by the DRIs. Conclusion: Food intake was inadequate as compared to the recommendations of the International Nutrition Guidelines.

Influence of pharmacotherapy complexity on compliance with the therapeutic objectives for HIV+ patients on antiretroviral treatment concomitant with therapy for dyslipidemia: INCOFAR Project

Objectives: To analyze the relationship between pharmacotherapeutical complexity and compliance of therapeutic objectives in HIV+ patients on antiretroviral treatment and concomitant dyslipidemia therapy. Materials and methods: A retrospective observational study including HIV patients on stable antiretroviral treatment during the past 6 months, and dyslipidemia treatment between January and December, 2013. The complexity index was calculated with the tool developed by McDonald et al. Other variables analyzed were: age, gender, risk factor of HIV, smoking, alcoholism and drugs, psychiatric disorders, adherence to antiretroviral treatment and lipid lowering drugs, and clinical parameters (HIV viral load, CD4 count, plasma levels of total cholesterol, LDL, HDL, and triglycerides). In order to determine the predictive factors associated with the compliance of therapeutic objectives, univariate analysis was conducted through logistical regression, followed by a multivariate analysis. Results: The study included 89 patients; 56.8% of them met the therapeutic objectives for dyslipidemia. The complexity index was significantly higher (p = 0.02) in those patients who did not reach the objective values (median 51.8 vs. 38.9). Adherence to lipid lowering treatment was significantly associated with compliance of the therapeutic objectives established for dyslipidemia treatment. A 67.0% of patients met the objectives for their antiretroviral treatment; however, the complexity index was not significantly higher (p = 0.06) in those patients who did not meet said objectives. Conclusions: Pharmacotherapeutical complexity represents a key factor in terms of achieving health objectives in HIV+ patients on treatment for dyslipidemia.