Adherence to and effectiveness of Highly Active Antiretroviral Treatment for HIV infection: assessing the bidirectional relationship

Abstract : It is well-established that high adherence to HAART is a major determinant of virological and immunological success. Furthermore, psycho-social research has identified a wide range of adherence factors. Our objective was to assess the bi-directional relationship between adherence and response to treatment among patients enrolled in the ANRS CO8 APROCOCOPILOTE study. An econometric approach was implemented through a bivariate twoequation simultaneous system, studying the factors associated with both adherence and undetectability of HIV plasma viral load. Our results highlight that good biological results induced by adherence reinforce continued adherence. This strengthens the argument that patients who do not experience rapid improvements in their immunological and clinical statuses after HAART initiation should be prioritized when developing adherence support interventions. Furthermore, it rules out the hypothesis that HAART leads to "false reassurance" among HIV infected patients.