World Journal of AIDS, 2013, 3, 239-250
http://dx.doi.org/10.4236/wja.2013.33032 Published Online September 2013 (http://www.scirp.org/journal/wja)
239
Treatment Adherence, Quality of Life and Clinical
Variables in HIV/AIDS Infection*
Ana Reis#, Marina Prista Guerra, Leonor Lencastre
Faculty of Psychology and Educational Sciences, Porto’s University, Porto, Portugal.
Received June 4th, 2013; revised July 4th, 2013; accepted August 4th, 2013
Copyright © 2013 Ana Reis et al. This is an open access article distributed under the Creative Commons Attribution License, which
permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
ABSTRACT
The purpose of the study was to analyze the relationship between treatment adherence, quality of life and clinical vari-
ables in HIV/AIDS Infection. The empirical study was conducted at two Portuguese hospitals (Porto and Lisbon) with a
sample of 295 outpatients diagnosed with HIV/AIDS attending the Infectology service and on antiretroviral medication,
during a 12-month period (February 2009 to February 2010). Data were collected by voluntary fulfillment of three
questionnaires: one for socio-demographic variables, one to Assess Adherence to Antiretroviral Treatment-HIV and the
Portuguese version of the WHOQOL-Bref to measure the quality of life (QoL). Clinical records were inspected in order
to collect clinical information from the patients. The relationship between these variables was accessed by Student’s
t-test and ANOVA using Tukey and LSD as the post Hoc test. Regarding disease stages, the post Hoc analysis has
showed that asymptomatic patients have a better level of adherence and quality of life when compared to those in more
advanced stages of the disease. Undetectable viral load <20 copies/mL and T CD4+ count >500 cells/mm3 were also
associated with higher QoL in all overall domains. Patients on NRTI + NNTRI regimens have higher adherence when
compared to those on NRTI + PI regimens and higher QoL indexes when compared to twice daily regimens, patients on
single dose per day regimens have higher adherence and higher QoL in overall domain. Patients experiencing adverse
effects have lower QoL and lower adherence levels when compared to those not experiencing such events. We consider
the multiplicity and the interaction of several determinants of influence in the adaptation process during the HIV/AIDS
treatment. The results may have implications for the psychological intervention to improve the adherence’s level to the
antiretroviral therapy.
Keywords: Adherence; Quality of Life; HIV/AIDS
1. Introduction
The introduction of Highly Antiretroviral Therapy (HAART)
has had a major impact on both life expectancy and qual-
ity of life of HIV-infected individuals [1-3]. Although
clearly providing significant benefits, combination ther-
apy is often associated with complicated regimens and
non-negligible side effects. The new generation of HIV
drugs offers the potential for long-term suppression of
HIV replication, however the challenge is to encourage
and enable patients to take these medications correctly, in
order to achieve their maximum effect. Some studies have
found that adherence lower than 95% can be associated
with the development of viral resistance to medication
[4-7]. HAART regimes are composed of several drugs
and distinct intake requirements (namely, with or without
food, once or twice daily, the need for special storage con-
ditions) for each drug within the regime, resulting in com-
plex regimens. Many patients report difficulties to meet
the requirements due to the complexity of treatment, re-
quiring intervention and psychological support to over-
come or improve the level of adherence to HAART [8].
If gaps in dose intake or other forms of inadequate ad-
herence occur, the virus acquires the ability to replicate
thereby increasing the risk of viral resistance [9]. The evi-
dence on the association between clinical variables and
HAART adherence is abundant [6,9-14] and indicates
that adherence is associated with lower viral load, higher
counts of lymphocytes T CD4+, asymptomatic stage, and
less experience of adverse events of antiretroviral medi-
cation [12,13,15].
*The authors declare no conflict of interest in publishing this article.
#(PhD Grant—Scholarship for Doctor’s Degree from the Science and
Technology Foundation—SFRH/BD/43241/2008).

Treatment Adherence, Quality of Life and Clinical Variables in HIV/AIDS Infection 240
Considering the relevance of the topic, this work,
which is part of a broader study [13] aims at analyzing
the relationship between treatment adherence, quality of
life, and HIV/AIDS infection surrogate markers.
2. Method
2.1. Ethics Statement
The study received favorable ethical statement from the
Portuguese Data Protection (CNPD) as well as by the
Joaquim Urbano’s hospital (Porto, Portugal) and Curry
Cabral’s hospital (Lisboa, Portugal) ethical committees.
The participation was voluntary and the informed con-
sent was signed by all participants.
2.2. Data Collection
The data was collected between February of 2009 and
February of 2010, in two major infectious disease centers
in Portugal (Joaquim Urbano Hospital in Porto and Curry
Cabral Hospital in Lisbon).
Patients on the same antiretroviral regimen for at least
3 months were invited, by the infectious disease special-
ist, to participate in the study.
The research protocol was completed, in the presence
of a psychologist, at the end of the physician appoint-
ment. This research protocol consisted of patients’ clini-
cal records inspection in order to collect participants’ cli-
nical information and the fulfillment of three question-
naires: one for socio-demographic variables, one to As-
sess Adherence to Antiretroviral Treatment-HIV (Por-
tuguese adaptation of the CEAT-VIH) [6,16] and one to
measure the quality of life (QoL) (Portuguese version of
the WHOQOL-Bref) [17].
2.3. Instruments
2.3.1. Q ue stionna ire Sample Char a ct er izati o n
This questionnaire includes information on both socio-
demographic variables (sex, age, civil status, occupation,
schooling) and clinical (mode of transmission, time since
infection, HIV stage [18], viral load, lymphocyte T CD4+
count, presence of adverse events of antiretroviral treat-
ment and current antiretroviral regimen.
2.3.2. Questionnaire for Assessing Adherence to
Antiretroviral Treatment (CEAT-VIH,
in the Original)
The CEAT-VIH is a 20 items multidimensional instru-
ment, of self-administration, validated for antiretroviral
regimen adherence assessment in HIV infected adult in-
dividuals. This quick and simple tool addresses the main
factors associated to adherence behaviors. The question-
naire score varies between 19 and 81 and a higher score
indicates a higher level of adherence to treatment [6,19].
The CEAT-VIH was originally developed in Spain [6]
and later adapted to Brazil [7] Colombia [20], Mexico
[21], Peru [22] and Roménia [23]. In the present study
[12,16] the CEAT-VIH was adapted to Portugal’s Portu-
guese and the internal consistency was assessed through
the Cronbach’s alpha (0.89 for the present study).
2.3.3. World Heal t h Or g an i zation Quality of Li fe—
WHOQOL-Bref
The WHOQOL-Bref, short version of WHOQOL-100, is
a tool of quality of life assessment organized in four do-
mains and a general feature (two items) regarding the as-
sessing of global quality of life [17]. The internal consis-
tency for each domain was assessed through the Cron-
bach’s alpha and it was the following: physical health
(0.78), psychological (0.79), social relationships (0.79)
and environment (0.83). The questionnaire score varies
between 0 and 100 with a higher score representing bet-
ter quality of life.
2.4. Participants
The sample was collected randomly in reference centers
mentioned above and it’s a non-representative sample.
As presented in Table 1, the sample consists of 295
participants diagnosed with HIV/AIDS Infection both
female (n = 105; 35.6%) and male (n = 190; 64.4%) and
aged between 19 and 81 years [Mean (M) = 40.9 years,
Standard Deviation (SD) = 9.5]. Regarding marital status,
47.5% are single, 36.6% are married and/or cohabitate)
and 12.9% are separated and/or divorced. Regarding edu-
cation, participants is distributed as follows: Basic Edu-
cation†: 1st cycle (n = 75; 25.4%), 2nd cycle (n = 70;
23.7%), 3rd cycle (n = 72; 24.4%); Secondary education
(n = 37; 12.5%) and Tertiary education (n = 26; 8.8%). In
what concerns occupation, 33.6% (n = 99) of the partici-
pants are professionally active, 39.3% (n = 116) unem-
ployed and 17.3% are retired (n = 51). The remaining
percentage correspond to domestic workers, people who
have never worked or are currently on sick leave (n = 29;
9.8%).
According to the data presented in Table 1 the most
frequent transmission mode was heterosexual sex (n =
159; 52.9%). At the time of interview, 56.9% participants
were in stage A1 (asymptomatic) of HIV infection [13]
and the average time of infection was 103.4 months (SD
= 60.2). Of the total number of participants included in
the sample, regarding clinical indicators of HIV/AIDS
infection, 34.6% have undetectable viral load (<20 cop-
ies/ml). Considering participants who are not with unde-
tectable viral load it was found that only 5.08% had val-
es above 100,000 copies. The average lymphocyte T u
†In Portugal, Basic Education consists of nine years of schooling di-
vided into three sequential cycles of education of four, two and three
y
ears.

Treatment Adherence, Quality of Life and Clinical Variables in HIV/AIDS Infection 241
Table 1. Clinical data (n = 295).
Clinical data Subcategories n % Min Max M SD
Mode of transmission
Heterosexual 156 52.9
Homosexual 36 12.2
IVDU 99 33.6
Disease stage CDC (Centre for Disease Control)
Asymptomatic 168 56.9
Symptomatic 49
AIDS 78
Time since infection (in months) 4 252 103.4 60.2
Viral load (HIV RNA cps/mL) <20 750,000 20688.391614.6
<20 102 34.6
20 - 50 128 43.4
51 - 500 20 6.8
501 - 10,000 14 4.7
10,001 - 30,000 1 0.3
>100,000 15 5.08
CD4+ count 8 1556 454.4 308.4
<200 65
22.0
200 - 350 63 21.4
351 - 500 65 22.0
>500 102 34.6
Third agent Drug Class
NRTI* + NNRTI** 194 66.4
NRTI + PI*** 98 33.6
Number of doses/d ay 1 3 1.5 0.5
1 158 53.6
2 134 45.4
3 3 1.0
Number of pills/day 1 9 3.7 1.8
1 26 8.8
2 53 18.0
3 90 30.5
4 37 12.5
>4 89 30.2
Adverse events of antiretroviral medication
yes 113
No 182
*Nucleoside reverse transcriptase inhibitors; **Non nucleoside reverse transcriptase inhibitors; ***Protease inhibitors.

Treatment Adherence, Quality of Life and Clinical Variables in HIV/AIDS Infection 242
CD4+ count was 455.8 (SD = 308.4), ranging between
and 1556. Of the total participants, 22% presented lym-
phocyte T CD4+ count <200. The most common antiret-
roviral regimen is a combination of two Nucleoside Re-
verse Transcriptase Inhibitors (NRTI) with one Non-nu-
cleoside Reverse Transcriptase Inhibitors (NNRTI) (53.9%).
The simplest regimen provides one pill per day and 8.8%
of the participants are under that regimen. 53.6% of the
participants are on a daily regimen and the average num-
ber of pills per day is 3. 7 (SD = 1.8). Finally, 38.3% of
participants reported experiencing side effects related to
antiretroviral therapy.
2.5. Procedures
Data Analysis
For data analysis it was used the informatics program
SPSS (Statistical Package for Social Sciences—version
17) to treat the data statistically. At first the data analysis
included a description of the variables in study. Then, for
the study of adherence and quality of life differences and
considering the clinical variables, it was used the para-
metric statistics after the normality of the sample was
tested and assumed (t tests of Student and ANOVA ana-
lysis with post-hoc Tukey and LSD).
3. Results
Tables 2 to 10 present the estimated association between
the variables under analysis (adherence and quality of life)
and the presumed relevant factors (clinical variables).
Overall, results suggest a statistically significant associa-
tion between clinical variables considered (viral load,
lymphocyte T CD4+ count, antiretroviral regimen, and
number of intakes per day, number of pills per day and
adverse events of antiretroviral medication at the time of
the data collection) and adherence and quality of life.
As shown in Table 2, it can be seen that there are sig-
nificant differences in adherence and in all domains of
quality of life, including the general facet, depending on
the CDC HIV stage [13]. In addition, Tukey’s tests were
calculated to detect the direction of these differences
having been found that infected individuals in an asymp-
tomatic stage have better compliance and higher scores
in all domains of quality of life. There were no statistical-
ly significant differences between the symptomatic pa-
tients and those undergoing AIDS (Table 3).
With regard to viral load, it can be verified by reading
Table 4 that adherence and quality of life are higher in
participants with undetectable viral load, except for the
field of social relations in which no statistically signifi-
cant differences were found. With respect to CD4+ T cell
count, statistically significant differences in adherence
and in all domains of quality of life, except for the psy-
chological domain (Table 5), were obtained. Through the
Tukey’s test (p < 0.001) it was found that participants
with CD4+ > 500/mm3 have higher adherence and better
quality of life (Table 6).
In terms of the therapeutic regimen, Table 7 shows
that participants with NRTI + NNRTI prescription pre-
sent higher compliance and better quality of life, in the
physical, environment and general facet. Table 7 also in-
dicates that participants who reported experiencing side
effects of antiretroviral therapy have lower levels of ad-
herence and worse quality of life.
With regard to the number of intakes per day, there are
statistically significant differences in adherence and qua-
lity of life for participants in a single dose regimen,
except for the domain of social relationships (Table 8).
Concerning the number of tablets per day there are
statistically significant differences in adherence and in
Table 2. Mean differences (One-Way ANOVA) in treatment adherence and quality of life according to HIV stage (CDC).
HIV stage (CDC)
Asymptomatic Symptomatic AIDS
(n = 168) (n = 49) (n = 78)
M SD M SD M SD F p
Adherence 74.18 8.62 65.57 10.72 68.72 12.34 17.29 <0.001
General QoL* 57.07 20.46 50.77 22.45 45.83 20.11 8.19 <0.001
QoL domains
Physical health 63.88 18.40 54.45 16.01 54.62 15.13 10.62 <0.001
Psychological 61.01 17.14 53.49 16.95 53.47 18.66 6.68 0.001
Social relationships 55.51 22.22 48.98 20.03 45.19 20.12 6.70 0.001
Environment 56.62 16.27 51.72 16.29 49.80 18.20 4.93 0.008
*Quality of life.

Treatment Adherence, Quality of Life and Clinical Variables in HIV/AIDS Infection 243
Table 3. Mean differences (One-Way ANOVA) in treatment adherence and quality of life according to HIV stage (CDC)—
Post-hoc Tukey.
HIV stage (CDC) HIV stage (CDC) Mean difference p
Symptomatic 8.61 <0.001
Asymptomatic
AIDS 5.46 <0.001 Adherence
Symptomatic AIDS −3.15 0.203
Symptomatic 6.30 0.15
Asymptomatic
AIDS 11.24 <0.001 General QoL*
Symptomatic AIDS 4.93 0.39
QoL domains:
Symptomatic 9.34 0.002
Asymptomatic
AIDS 9.26 <0.001 Physical health
Symptomatic AIDS −0.18 0.99
Symptomatic 7.53
0.02
Asymptomatic
AIDS 7.54 0.005
Psychological
Symptomatic AIDS 0.014 1.00
Symptomatic 6.26 0.15
Asymptomatic
AIDS 10.31
0.001 Social relationships
Symptomatic AIDS 3.79 0.59
Symptomatic 4.90 0.17
Asymptomatic
AIDS 6.82 0.009 Environment
Symptomatic AIDS 1.92 0.81
*Quality of life.
Table 4. Mean differences (One-Way ANOVA) in treatment adherence and quality of life according to the viral load.
Viral load
<20 >20
(n = 102) (n = 193)
M SD M SD t p
Adherence 77.43 5.20 68.07 11.33 9.71 <0.001
General QoL* 56.37 18.08 51.30 22.53 2.10 0.04
QoL domains:
Physical health 66.60 17.65 56.31 16.81 4.91 <0.001
Psychological 63.97 16.03 54.49 17.95 4.47 <0.001
Social relationships 53.76 21.83 50.60 21.68 1.19 0.24
Environment 57.02 14.46 52.41 18.07 2.38 0.02
*Quality of life.
the physical and environment domains and on the overall
quality of life facet in favor of participants who take 1
pill per day (Ta ble 9).
It was carried out a post-hoc LSD (p < 0.001) and it
was found that the statistically significant differences
regarding adherence are among the participants taking 1

Treatment Adherence, Quality of Life and Clinical Variables in HIV/AIDS Infection 244
Table 5. Mean differences (Student’s t-test) in treatment adherence and quality of life according to the CD4+ count.
CD4+ count
<200 200 - 350 351 - 500 >500
(n = 65) (n = 63) (n = 65) (n = 102)
M SD M SD M SD M SD F p
Adherence 67.14 12.61 71.21 10.53 71.52 9.56 73.88 9.19 5.59 0.001
General QoL* 43.85 19.15 51.29 19.89 55.38 21.19 58.33 21.50 6.95 <0.001
QoL domains
Physical health 54.89 14.29 57.20 18.51 61.76 17.69 63.48 18.59 3.94 0.009
Psychological 53.97 18.67 55.95 15.50 59.42 18.41 60.25 18.06 2.06 0.11
Social relationships 45.00 20.67 49.07 19.98 52.69 23.25 56.94 21.37 4.55 0.004
Environment 49.90 17.30 51.34 14.82 54.66 17.23 57.84 17.34 3.63 0.01
*Quality of life.
pill a day and those taking 2, between those who take 1
and 3, between those who take 1 and 4 and those who
take 1 and more than 4 tablets per day. For the overall
quality of life facet it was verified that the statistically
significant differences are among participants taking 1
pill a day and those taking 2, among those taking 1 and 3,
among those taking 1 and 4, among those who take 1 and
more than 4, among those taking 2 and 4 and among
those taking more than 4 tablets per day (Table 10).
4. Discussion
The aim of this study was to analyze the relationship be-
tween treatment adherence, quality of life and clinical va-
riables in HIV/AIDS infection. Some disease and treat-
ment related variables appear to compromise adherence
and quality of life levels. It was found statistically signi-
ficant differences in adherence and quality of life in rela-
tion to HIV stage and biological markers of HIV infec-
tion-viral load and on the CD4+ T cell count, which is in
agreement with other studies [6,9,10]. With respect to
disease stage, while some studies indicate improved ad-
herence in symptomatic and AIDS stage patients [11,24,
25] that does not happen in our study: our results suggest
that asymptomatic subjects show a higher adherence
level. One possible explanation for this result is that fear
of future complications may create an incentive for in-
creased adherence in asymptomatic patients.
Considering the biological markers it was found that
subjects with undetectable viral load and CD4 + T > 500
cell count have better levels of adherence and better in-
sight of quality of life. These results are in line with
those presented in the literature on the benefits of anti-
retroviral therapy in reducing viral load and restoration
of immunity [6,9,10,14].
With respect to therapeutic regimen, the available evi-
dence suggests that want both the number of daily in-
takes [25] and the number of pills per day [26,27] are of
relevance in increasing the probability of higher adher-
ence levels. Our results confirm that evidence, indeed we
find that patients on a single tablet regimen have both
higher adherence and higher quality of life. These results
reinforce the importance of the complexity of the treat-
ment as adherence barrier [28]. Further, they reinforce
the fact the lower the level of interference of treatment in
daily life, the higher the average adherence level [6,10,
29].
With regard to side effects, as expected participants
who reported experiencing side effects associated with
antiretroviral treatment are found to have a lower adher-
ence levels and worse quality of life. This result is en-
tirely consistent with prior studies on the impact side ef-
fects can have on the adherence and quality of life [12,
30]. Indeed, side effects (often severe and complex) are
described in the literature as predictors of poor adherence
[29]. It is, thus, important to monitor side effects when
starting or switching therapy [31].
5. Conclusions
Clinical variables and regimen characteristics were found
to be associated with adherence and QoL. We were able
to find significant evidence of positive association be-
tween treatment simplification in adherence and QoL.
For instance, reducing the number of pills and the num-
ber of daily doses is found to be associated with higher
adherence and better QoL. The results also reinforce the
widely described in the literature barrier to adequate ad-
herence generated by treatment complexity. These aspects
should thus be considered when defining interventions to
improve adherence to antiretroviral therapy.
The study does have some limitations. Adherence was

Treatment Adherence, Quality of Life and Clinical Variables in HIV/AIDS Infection 245
Table 6. Mean differences (Student’s t-test) in treatment adherence and quality of life according to the CD4+ cell count—
Post-hoc Tukey.
CD4+ cell count CD4+ cell count Mean difference p
200 - 350 −4.07 0.12
351 - 500 −4.39 0.08
<200
>500 −6.74 <0.001
351 - 500 −0.32 0.99
200 - 350
>500 −2.68 0.38
Adherence
351 - 500 >500 −2.36 0.48
200 - 350 −7.74 0.15
351 - 500 −11.54 0.008 <200
>500 −14.49 <0.001
351 - 500 −3.97 0.72
200 - 350
>500 -6.75 0.17
General QoL*
351 - 500 >500 −2.95 0.80
QoL domains
200 - 350 −2.31 0.88
351 - 500 −6.86 0.16 <200
>500 −8.56 0.01
351 - 500 −4.56 0.46
200 - 350
>500 −6.28 0.12
Physical health
351 - 500 >500 −1.72 0.93
200 - 350 −1.98 0.92
351 - 500 −5.45 0.33 <200
>500 −6.23 0.18
351 - 500 −3.47 0.69
200 - 350
>500 −4.30 0.43
Psychological
351 - 500 >500 −0.83 0.99
200 - 350 −4.07 0.70
351 - 500 −7.69 0.17
<200
>500 −11.99 0.003
351 - 500 −3.17 0.77
200 - 350
>500 −7.87 0.10
Social relationships
351 - 500 >500 −4.25 0.59
200 - 350 −1.44 0.96
351 - 500 −4.76 0.37
<200
>500 −7.94 0.02
351 - 500 −3.32 0.67
200 - 350
>500 −6.50 0.08
Environment
351 - 500 >500 −3.18 0.63
*Quality of life.

Treatment Adherence, Quality of Life and Clinical Variables in HIV/AIDS Infection 246
Table 7. Mean differences (Student’s t-test) in treatment adherence and quality of life according to the class of drug and ad-
verse event s of antire t r o viral medication.
Class of drug Adverse events of antiretroviral
medication
NRTI* +
NNRTI** NRTI + PI*** Yes No
(n = 194) (n = 98) (n = 113) (n = 182)
M SD M SD t p M SD M SD t p
Adherence 72.40 10.44 69.08 10.830.35 0.012 66.96 11.23 74.00 9.23 5.57 <0.001
General QoL**** 55.73 19.76 47.32 22.653.27 0.001 47.57 22.15 56.46 19.92 3.57 <0.001
QoL Domains:
Physical health 61.43 18.01 56.74 17.142.14 0.12 55.03 16.97 62.87 17.62 3.77 <0.001
Psychological 58.87 17.04 55.40 19.251.57 0.12 58.88 17.54 60.81 17.43 3.79 <0.001
Social relationships 51.46 21.43 57.79 22.430.12 0.90 47.12 20.77 54.53 21.91 2.88 0.004
Environment 55.32 16.60 51.15 17.491.99 0.04 50.11 15.92 56.42 17.28 3.14 0.002
*Nucleoside reverse transcriptase inhibitors; **non nucleoside reverse transcriptase inhibitors; ***protease inhibitors; ****quality of life.
Table 8. Mean differences (Student’s t-test) in treatment adherence and quality of life according to the number of doses per
day.
Number of doses per day
1 2
(n = 158) (n = 134)
M SD M SD t p
Adherence 73.54 9.56 6893 11.18 3.76 <0.001
General QoL* 55.93 20.14 4963 22.16 2.55 0.001
QoL domains
Physical health 61.84 17.25 57.41 18.07 2.14 0.03
Psychological 60.86 16.28 54.32 19.00 3.13 0.002
Social relationships 52.06 21.99 51.24 21.66 0.32 0.75
Environment 56.59 16.01 50.93 17.80 2.86 0.005
*Quality of life.
Table 9. Mean differences (One-Way ANOVA) in treatment adherence and quality of life according to the number of pills per
day.
Number of pills per day
1 2 3 4 >4
(n = 26) (n = 53) (n = 90) (n = 37) (n = 89)
M SD M SD M SD M SD M SD F p
Adherence 78.04 5.11 73.11 10.84 71.63 10.57 68.709.27 69.01 11.36 4.84 0.001
General QoL* 64.90 13.70 58.25 19.14 53.7521.97 46.9618.96 48.31 22.39 4.98 0.001
QoL domains
Physical health 66.62 16.93 63.14 16.59 60.6318.42 55.12 16.3856.98 17.82 2.83 0.03
Psychological 61.38 14.56 60.61 16.09 58.56 18.07 54.2817.19 55.66 19.50 1.31 0.27
Social relationships 53.53 22.51 51.10 19.86 51.67 22.66 50.0019.64 52.25 22.85 0.13 0.97
Environment 58.05 14.80 57.96 15.87 54.9017.75 49.58 15.4751.40 17.62 2.33 0.05
*Quality of life.

Treatment Adherence, Quality of Life and Clinical Variables in HIV/AIDS Infection 247
Table 10. Mean differences (One-Way ANOVA) in treatment adherence and quality of life according to the number of pills
per day—Post-hoc LSD.
Pills per day Pills per day Mean difference p
2 4.93 0.048
3 6.41
0.006
4 9.34 0.001
1
>4 9.03 <0.001
3 1.48 0.41
4 4.41
0.048 2
>4 4.10 0.02
4 2.93 0.15
3 >4 2.62 0.09
Adherence
4 >4 −0.31 0.88
2 6.65 0.18
3 11.15
0.02
4 17.94 0.001
1
>4 11.59 <0.001
3 4.51 0.21
4 11.23 0.01 2
>4 9.94 0.006
4 6.80 0.09
3
>4 5.45 0.08
General QoL*
4 >4 −1.34 0.74
QoL domains
2 3.21 0.45
3 5.90 0.13
4 11.51 0.01
1
>4 9.64 0.01
3 2.78 0.36
4 8.30 0.03
2
>4 6.43 0.04
4 5.52 0.12
3 >4 3.65 0.17
Physical health
4 >4 -1.87 0.59
2 0.77 0.86
3 2.81 0.48
4 7.09 0.12
1
>4 5.71 0.15
3 2.05 0.51
4 6.33 0.98 2
>4 4.95 0.11
4 4.30 0.22
3 >4 2.90 0.28
Psychological
4 >4 −1.39 0.69

Treatment Adherence, Quality of Life and Clinical Variables in HIV/AIDS Infection 248
Continued
2 2.43 0.64
3 1.86 0.70
4 3.53 0.53
1
>4 1.28 0.80
3 −0.57 0.88
4 1.10 0.81 2
>4 −1.15 0.76
4 1.68 0.70
3 >4 −0.58 0.86
Social relationships
4 >4 −2.25 0.60
2 0.09 0.98
3 3.16 0.40
4 8.48 0.05
1
>4 6.65 0.08
3 3.06 0.30
2 4 8.38
0.02
>4 6.56 0.03
3 4 5.32 0.11
>4 3.50 0.17
Environment
4 >4 −1.83 0.58
*Quality of life.
assessed through a self-reporting adherence questionnaire
and these results then confronted with biological markers
(patient’s viral load and CD4 count). Despite concerns
that self-reporting may overestimate adherence, it has been
demonstrated that self-reported adherence has been con-
sistently correlated with viral load and clinical outcomes
in HIV treatment [6,12,16] and has been deemed a robust
and appropriate indicator of adherence.
This study is a cross-sectional study, which measured
adherence and QoL at a single time point. However, ad-
herence and QoL are dynamic processes that may change
over time. Longitudinal studies with a wider range of re-
spondents and the use of a combination of adherence as-
sessment tools are necessary to understand adherence and
QoL over time and to explore the factors that influence
adherence to antiretroviral therapy in the longer term,
which could most likely reduce the risk of overestimation
[32].
6. Acknowledgements
The authors would like to thank Gilead Sciences Ltd., for
supporting the manuscript preparation.
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