Adherence to Antiretroviral Therapy: Prevalence, Determinants and Impact on Body Weight and Immunological Recovery among People Living with Human Immunodeficiency Virus in Osogbo, Nigeria
Adeolu Oladayo Akinboro *
Department of Internal Medicine, Ladoke Akintola University of Technology, and LAUTECH Teaching Hospital Ogbomoso, Oyo State, Nigeria.
Abdulkareem Afolabi Salawu
Department of Chemical Pathology, Ladoke Akintola University of Technology and LAUTECH Teaching Hospital Ogbomoso, Oyo State, Nigeria.
Roseline Opeyemi Awoyemi
People Living with Human Immunodeficiency Virus (PLWHIV) Clinic LAUTECH Teaching Hospital Osogbo, Osun State, Nigeria.
Olugbenga Edward Ayodele
Department of Internal Medicine, Ladoke Akintola University of Technology, and LAUTECH Teaching Hospital Ogbomoso, Oyo State, Nigeria.
*Author to whom correspondence should be addressed.
Abstract
Background: antiretroviral therapy has changed the outlook of AIDS. However, identifying factors that will strengthen its maintenance is vital to treatment success. Advocacy is growing on the need for close attention to immunological progress, prevention of excessive body weight gain and associated immunological and metabolic consequences for better long-term outcomes among PLWHIV in Africa.
Aims: To study prevalence, determinants of adherence, and the existing relationship between body weight and CD4 count among adherents and non-adherent patients on HAART.
Methodology: A cross-sectional design for sampling of 270 patients on HAARTS was made and pharmacy based adherence was calculated. Patients were categorized into weight groups according to WHO guideline and CD4 count was determined at baseline, third and sixth months.
Result: Calculated overall pharmacy adherence was 62.6% over six months. Disclosure to a close family member (p=0.013) and living outside the city of care (p=0.025) significantly predict adherence. Pretreatment overweight (BMI-25- 29.9) and obesity (BMI>30.0) were temporary beneficial to CD4 constitution at baseline (p=0.004), while overweight (p=0.041) and obesity (p=0.150) were associated with lower CD4count repopulation at six months post- HAART compared to normal body weight (BMI-18.5– 24.9), pË‚0.001. Adherent PLWHIV participants had higher body weight increasing effect, but demonstrated lower CD4 lymphocyte count increasing effect compared to the non-adherent at six months post-HAART, (p<0.001).
Conclusion: Normal body weight and maintenance during HAART seems beneficial for immune reconstitution at six months post- HAART. While emphasizing good adherence to HAART, it becomes necessary for programme implementers to watch against excessive body weight gain and attendants adverse immunological consequences.
Keywords: Adherence, HAART, PLWHIV, overweight, obesity, Osogbo, Nigeria