Morphologic alterations in HIV-infected people with lipodystrophy are associated with good adherence to HAART

Objective: To evaluate the association between adherence to drugs and morphologic alterations (MOA) in a cohort of HIV-infected patients on HAART. Method: This was a cross-sectional multicenter cohort study in eight tertiary Clinical Centers of Northern and Central Italy. Consecutive outpatients taking HAART were enrolled from August 2000 to March 2001. They completed a self-administered questionnaire for the evaluation of signs of MOA and the self-reported adherence to drugs. Main outcome measures were MOA according to the Multicenter AIDS Cohort Study (MACS) definition and adherence to drugs. Results: One hundred seventy-five persons were enrolled into the study. Median CD4 cell count was 522 (interquartile range [IQR] 306-720); 35% of people had undetectable HIV RNA. Patients had been taking HAART for a median of 53 months (IQR 33-62). Among enrolled patients, 83 (47%) had a diagnosis of self-reported MOA; 57 of them reported body changes of more than 12 months duration. Forty persons (23%) self-reported nonadherence in the previous week. Mean time on HAART was 48.7 months (SD = 19.7) for people with MOA and 42.1 months (SD = 21.8) for those without MOA (p =.043). The odds of adherence for people with MOA was 2.36 times (95% CI 1.11-5.00) higher than for people without MOA. On multivariate analysis, being older and female, having an undetectable HIV RNA, longer duration on HAART, and self-reported adherence were independently associated with the presence of MOA. In people with MOA, adherence seems to decrease over time. Conclusion: Longer time on HAART and self-reported adherence were correlated to MOA. MOA was also associated with older age and female gender.