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HIV 感染患者对高效抗逆转录病毒疗法(HAART)的依从性:从预测性方法到动态方法。

Adherence to highly active antiretroviral therapies (HAART) in HIV-infected patients: from a predictive to a dynamic approach.

作者信息

Spire Bruno, Duran Ségolène, Souville Marc, Leport Catherine, Raffi François, Moatti Jean-Paul

机构信息

INSERM U 379, Torrents, Marseille, France.

出版信息

Soc Sci Med. 2002 May;54(10):1481-96. doi: 10.1016/s0277-9536(01)00125-3.


DOI:10.1016/s0277-9536(01)00125-3
PMID:12061483
Abstract

To-date, most socio-behavioural research about HTV-infected patients' adherence to highly active antiretroviral therapies (HAART) has been based on cross-sectional studies. The French APROCO cohort gave us the opportunity to conjointly analyse the relationships between short-term adherence to HAART and HIV-infected patients' characteristics before initiation of treatment on the one hand, factors related to patients' subjective experience with HAART on the other hand. At the fourth-month follow-up visit (M4) after first prescription of HAART (M0), 26.7% of our sample of 445 patients self-reported non-adherence behaviour. Some patients' characteristics at M0 (younger age, poor housing conditions, lack of social support, and problems of adherence with previous antiretroviral regimens) were related to non-adherence at M4 in multivariate analysis. Non-adherence at M4 was, however, also related to the evolutions that affected a number of factors between M0 and M4: levels of depression, symptoms associated with treatment side effects, perception of individual state of health, beliefs towards effectiveness and toxicity of HAART. increases in alcohol and tobacco consumption, as well as contacts with other physicians than hospital HAART prescribers. Our prospective study brings additional evidence that even short-term non-adherence cannot be reliably predicted on the sole basis of a few a priori patient characteristics that clinicians could easily identify before initiation of HAART. It suggests that a dynamic approach to adherence, continuously monitoring the impact of experience with HAART on patients' daily lives, is needed for improving management of HIV/AIDS care.

摘要

迄今为止,大多数关于感染艾滋病毒患者对高效抗逆转录病毒疗法(HAART)依从性的社会行为研究都是基于横断面研究。法国的APROCO队列研究使我们有机会一方面联合分析开始治疗前HAART短期依从性与艾滋病毒感染患者特征之间的关系,另一方面分析与患者HAART主观体验相关的因素。在首次开具HAART处方(M0)后的第四个月随访(M4)时,我们445名患者样本中有26.7%的患者自我报告有不依从行为。多因素分析显示,M0时的一些患者特征(年龄较小、住房条件差、缺乏社会支持以及既往抗逆转录病毒治疗方案的依从性问题)与M4时的不依从有关。然而,M4时的不依从也与M0和M4之间影响若干因素的变化有关:抑郁水平、与治疗副作用相关的症状、对个人健康状况的认知、对HAART有效性和毒性的信念、酒精和烟草消费量的增加,以及与医院HAART开方医生以外的其他医生的接触。我们的前瞻性研究提供了更多证据,表明即使是短期不依从也不能仅根据临床医生在开始HAART之前容易识别的一些先验患者特征可靠预测。这表明,需要一种动态的依从性管理方法,持续监测HAART体验对患者日常生活的影响,以改善艾滋病毒/艾滋病护理管理。

相似文献

[1]
Adherence to highly active antiretroviral therapies (HAART) in HIV-infected patients: from a predictive to a dynamic approach.

Soc Sci Med. 2002-5

[2]
Perspectives on adherence and simplicity for HIV-infected patients on antiretroviral therapy: self-report of the relative importance of multiple attributes of highly active antiretroviral therapy (HAART) regimens in predicting adherence.

J Acquir Immune Defic Syndr. 2004-7-1

[3]
[Economic and socio-behavioural issues related to highly active antiretroviral therapies for HIV infection: the contribution of social science research].

Med Sci (Paris). 2003

[4]
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[5]
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[6]
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[7]
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J Antimicrob Chemother. 2009-9

[8]
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Addiction. 2004-3

[9]
HAART adherence in culturally diverse patients with HIV/AIDS: a study of male patients from a Veteran's Administration Hospital in northern California.

AIDS Patient Care STDS. 2001-3

[10]
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Int J Behav Med. 2003

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