The majority of HIV-positive Brazilian women do not adhere properly to their HAART regimens, however, if a woman is pregnant her adherence is better, according to a poster presentation to the 43rd ICAAC in Chicago on September 15th.
The finding that Brazilian women have low levels of adherence is in stark contrast to Brazilian adherence studies presented to the International AIDS Society conference in Paris in July, which suggested that HAART-treated Brazilians usually achieve very high levels of adherence to anti-HIV therapy.
A prospective cohort of 72 HIV-positive pregnant women and 79 HIV-positive women who were not pregnant and receiving care at a public HIV clinic at a university in San Paulo were included in the study. Adherence was assessed monthly using a pill count and a structured questionnaire which asked about pill taking in the previous four days. Women were assessed as adherent if they took at least 95% of their doses correctly.
There were no social or educational differences between the pregnant and non-pregnant women. The pregnant women, however, tended to be younger (mean age 29 years versus 39 years, p
The number of pills which the pregnant women were being asked to take was significantly higher than the number that non-pregnant women were taking, with 63.9% taking six or more pills a day compared to only 13.9% of their non-pregnant peers (p
According to the pill count, 43.1% of pregnant women achieved 95% adherence. This was significantly higher than non-pregnant women: only 17.7% of non-pregnant women managed to take at least 95% of their doses (p
The level of adherence to protease inhibitor-containing regimens was not significantly worse than adherence to those containing an NNRTI (p=0.74), despite the fact that protease inhibitors are associated with higher pill counts and more side-effects.
Factors independently associated with higher levels of adherence were being pregnant (odds ratio [OR] 2.5), being aged at least 29 years (OR = 3.5), and a pill burden of six or less a day (OR = 2.6).
The investigators concluded that optimum adherence to HAART was rare. Even though pregnant women achieved better levels of adherence than those who were not pregnant, the average level of adherence was still low, and at such a suboptimal level that effective antiretroviral prophylaxis to prevent mother-to-baby transmission of HIV could be compromised. It should, however, be pointed out that this conclusion is flawed as the investigators did not gather data on adherence to therapy at delivery and post-partum, which is key to preventing mother-to-baby transmission of HIV.
Vaz MJR et al. Adherence with antiretroviral therapy during pregnancy. 43rd ICAAC, abstract H-859, Chicago September 14 - 17th, 2003.