Adherence, Not CD4 Counts, Is Critical

Although previous research has suggested that starting highly active antiretroviral therapy before CD4 counts fall below 350 is linked with better long-term treatment success, a study by Canadian researchers suggests that medication adherence is a more important factor. The researchers examined the roles of baseline CD4 counts and drug adherence in survival rates of 1,422 HIV-positive patients and found that the mortality rate for patients less than 75% adherent to their regimens was twice as high as the rate for those more adherent, regardless of their baseline counts. Patients with lower baseline CD4 counts who were adherent at least 75% of the time fared as well as those with higher baseline counts who were similarly adherent. 'These data suggest that patient nonadherence, instead of when antiretroviral therapy is initiated before a CD4 count of 200 cells, may be the strongest determinant of patient survival,' the researchers wrote in the November 18 edition of ,i>Annals of Internal Medicine.