Africans more likely to follow HIV therapy

HIV-infected patients in sub-Saharan Africa are more likely to adhere closely to their treatment regimen than are patients in North America, a multinational team of researchers reports in the Journal of the American Medical Association.

"One concern has been that individuals in extreme poverty in sub-Saharan Africa would have a hard time taking their medications, and that this would lead to drug resistance in the individual that could spread throughout the larger population," Dr. David R. Bangsberg told Reuters Health.

As a result, "adherence became a focal point as to how successful expanding (anti-HIV drug) programs would be," he added.

Bangsberg, an epidemiologist at the University of California in San Francisco, and his colleagues conducted an extensive literature search and identified 31 studies from North America and 27 from sub-Saharan Africa. The number of subjects per study was around 219 in North America and 100 in Africa.

Seventy-seven percent of African patients used their anti-HIV drugs as directed compared with 55 percent of North American patients. On final analysis, African patients were 2.5-times more likely to adhere to their treatments.

The expectation that people will not adhere to their medication "is not a sound reason to delay expansion of HIV treatment programs in sub-Saharan Africa," Bangsberg emphasized.

He especially hopes that multinational anti-HIV drug programs will see that patients in sub-Saharan Africa "are doing extraordinarily well in taking their meds."

Bangsberg said it is now important "to focus on what we can do to sustain this level of adherence, and also to make sure that issues around drug supply and drug distribution become the first point of concern."

He pointed out that patients in Africa may become less adherent as duration of treatment grows and as the potential for side effects also increase. He stressed, however, that it is "easier to sustain high levels of adherence than to improve suboptimal levels of adherence that are present to start with."

SOURCE: Journal of the American Medical Association, August 9, 2006.