Hindawi Publishing Corporation AIDS Research and Treatment Volume 2010, Article ID 142076, 6 pages doi:10.1155/2010/142076 Research Article Simpliﬁed Assessment of Antiretroviral Adherence and Prediction of Virological Efﬁcacy in HIV-Infected Patients in Cambodia Olivier Segeral,1 Yoann Madec,2 Boroath Ban,3 Vara Ouk,3 Chan Roeurn Hak,3 Clotilde Le Tiec,4 Eric Nerrienet,5 Ce´ cile Goujard,1 Anne Marie Taburet,4 Jean Francois Delfraissy,1 and Arnaud Fontanet2 1 Service de M´edecine Interne, Centre Hospitalier Universitaire de Bicˆetre, AP-HP, 94270 Le Kremlin Bicˆetre, France 2 Unit´e d’Epid´emiologie des maladies ´emergentes, Institut Pasteur, 75015 Paris, France 3 Service de Maladies Infectieuses, Hoˆpital Calmette, 12100 Phnom-Penh, Cambodia 4 Service de Pharmacologie, Centre Hospitalier Universitaire de Bicˆetre, AP-HP, 94270 Le Kremlin Bicˆetre, France 5 Laboratoire VIH/H´epatites, Institut Pasteur, 12100 Phnom-Penh, Cambodia Correspondence should be addressed to Olivier Segeral, oliseg@hotmail.com Received 18 August 2009; Accepted 24 November 2009 Academic Editor: Patrice K. Nicholas Copyright © 2010 Olivier Segeral 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. Background. Adherence to antiviral therapy is important for HIV-infected people living in low- and middle-income countries, because of poor access to alternative regimens. Methods. We conducted a cross-sectional survey of adherence in Cambodian patients enrolled in the ESTHER program and treated with WHO ﬁrst-line regimen for at least 6 months. The survey was based on a self-report questionnaire, drug assay, MCV measurement, visual analog scale, and viral load HIV RNA. Results. Two hundred ﬁfty-nine patients treated for a median of 16 months participated in the survey. At inclusion in the program, 158 patients (61%) were ARV-na¨ıve. The virological success rate was 71% overall and 81% in previously ARV-naive patients. Considered individually, the measures suggested perfect adherence in 71% to 93% of patients. In multivariate analysis adjusted for sex and therapeutic status before HAART initiation, only the biological markers were associated with virological eﬃcacy. Self-funded treatment before entry to the program was highly predictive of virological failure. Conclusion. Adherence was excellent in these Cambodian patients. Biological markers were predictive of virological eﬃcacy. MCV might thus serve as a simple alternative for assessing adherence and predicting virological eﬃcacy among patients receiving AZT- or d4T-based regimens. 1. Introduction Since highly active antiretroviral therapy (HAART) became widely available in industrialized countries, mortality and morbidity among patients living with HIV/AIDS have been substantially reduced [1]. Recently, access to ARV has improved in low- and middle-income countries. In late 2007, three million people in such countries were receiving HAART [2]. Numerous initiatives have shown that countries such as Brazil, Thailand, and Senegal can provide HAART on a large scale by using produced generic drugs [3– 5], and that smaller programs can provide HAART in local healthcare centres [6–10]. These cohort studies also demonstrated the eﬃcacy of World Health Organization- (WHO-)recommended ﬁrst-line HAART regimens, mainly thanks to excellent adherence to treatment [10–12]. It is particularly important to assess adherence during HAART programs, mainly owing to the limited availability of alternative regimens [13]. Indeed, poor adherence can lead to the emergence of drug resistance [14–16], notably to ﬁrst-line nonnucleoside reverse transcriptase inhibitor (NNRTI-)based regimens recommended by WHO. In coun- tries with poor access to laboratory monitoring (CD4 cell count and viral load), it has been suggested that treatment monitoring could be based simply on physical examination and adherence evaluation [17]. Educational and support programs can improve adherence [18–20]. Adherence is diﬃcult to evaluate, however. Self-report questionnaires have been widely used, for their low cost and simplicity, in both industrialized and developing countries [21, 22]. Visual analog scales have also recently been used to assess adherence [23, 24]. However, the accuracy of these