Unlike Americans, patients in Africa stick to HIV drugs

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HIV-infected patients in sub-Saharan Africa adhere better to treatment regimens than those from North America, a review of previous medical studies suggests.

Researchers in Canada compared anti-retroviral treatment (ART) compliance of nearly 17,600 persons infected with the AIDS virus who participated in 31 North American studies with slightly more than 12,100 HIV-infected patients examined in 27 sub-Saharan African studies.

The results were surprising, given that investigators determined an estimated 55 percent of those in the predominantly U.S.-based North American studies in “resource-rich” settings “achieved adequate levels of adherence,” compared with 77 percent of those in studies from poorer African settings.

“There has been concern that African patients, many of whom live in poverty and lack formal education, will have suboptimal adherence to ART,” said authors of the study, published in today’s issue of the Journal of the American Medical Association.

Instead, the findings “indicate that favorable levels of adherence, much of which was assessed via patient self-report, can be achieved in sub-Saharan settings and that adherence remains a concern in North America,” wrote lead author Edward Mills of the Centre for International Health and Human Rights Studies in Toronto.

In their report, Mr. Mills and colleagues point out that ART has “improved the health of many HIV-positive individuals who otherwise would have died.”

But they say “consistently high levels of adherence are necessary for reliable viral suppression and prevention of resistance, disease progression and death.” They acknowledge the regimens for those taking ART cocktails are “often complicated” and can require different dosing schedules and dietary restrictions and can mean “adverse effects.”

Although sub-Saharan Africa contains only about 10 percent of the world’s population, the authors point out that it “represents 77 percent of women with HIV, 79 percent of AIDS deaths, and 92 percent of the world’s AIDS orphans.”

Data from the 2006 Report on the Global AIDS Epidemic show that the number of people in sub-Saharan Africa taking ART has risen from about 20,000 in late 2002 to 800,000 by the end of last year. The United States has provided the lion’s share of that assistance.

However, approximately 12 million people were living with HIV in sub-Saharan Africa as of the end of 2005, half of them 15 to 49 years old, according to the same data.

An analysis of factors primarily responsible for negative adherence in that part of Africa found the “most important and prevalent” to be the high costs of ART, patients’ refusal to admit they are HIV-positive, alcohol abuse and difficulty in following complex drug regimens, the Toronto researchers said.

The North American studies found that impoverished individuals had “suboptimal adherence” but barriers to their compliance included poor patient-clinician relationships, untreated depression and substance abuse.

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