Chesney M A
School of Medicine, University of California San Francisco, San Francisco, CA 94105, USA.
Clin Infect Dis. 2000 Jun;30 Suppl 2:S171-6. doi: 10.1086/313849.
In both clinical trials and clinical practice, nonadherence to medications is widespread among patients with chronic diseases. The shift to combination therapies for treating human immunodeficiency virus (HIV)-infected individuals has increased adherence challenges for both patients and health-care providers. Estimates of average rates of nonadherence to antiretroviral therapy range from 50% to 70%. Adherence rates of <80% are associated with detectable viremia in a majority of patients. The principal factors associated with nonadherence appear to be patient-related, including substance and alcohol abuse. However, other factors may also contribute, such as inconvenient dosing frequency, dietary restrictions, pill burden, and side effects; patient-health-care provider relationships; and the system of care. We discuss the major reasons reported by HIV-infected individuals for not taking their medications. Improving adherence probably requires clarifying the treatment regimen and tailoring it to patient lifestyles.
在临床试验和临床实践中，慢性病患者不坚持服药的情况普遍存在。向联合疗法治疗人类免疫缺陷病毒（HIV）感染者的转变，给患者和医护人员带来了更大的坚持治疗挑战。抗逆转录病毒疗法的平均不坚持率估计在50%至70%之间。大多数患者中，坚持率低于80%与可检测到的病毒血症有关。与不坚持治疗相关的主要因素似乎与患者自身有关，包括药物和酒精滥用。然而，其他因素也可能起作用，如给药频率不便、饮食限制、药片负担和副作用；患者与医护人员的关系；以及护理体系。我们讨论了HIV感染者报告的不服药的主要原因。提高坚持率可能需要明确治疗方案并使其适应患者的生活方式。
