更简单的治疗方案可能会提高HIV感染患者对抗逆转录病毒药物的依从性。

Simpler regimens may enhance adherence to antiretrovirals in HIV-infected patients.

作者信息

Maggiolo Franco, Ripamonti Diego, Arici Claudio, Gregis Giampietro, Quinzan Giampaolo, Camacho Gary Antezana, Ravasio Laura, Suter Fredy

机构信息

Divisione di Malattie Infettive, Ospedali Riuniti, Bergamo, Italy.

出版信息

HIV Clin Trials. 2002 Sep-Oct;3(5):371-8. doi: 10.1310/98b3-pwg8-pmyw-w5bp.

DOI:10.1310/98b3-pwg8-pmyw-w5bp

PMID:12407486

Abstract

BACKGROUND

Optimal adherence to highly active antiretroviral therapy (HAART) is necessary to achieve the best and the most durable benefit. Many factors may influence compliance to such demanding regimens, and their identification may help in the design of strategies to enhance adherence.

PURPOSE

To assess the factors associated with lower compliance to therapy, the causes of nonadherence, and the relation of nonadherence with virologic response.

METHOD

We performed an observational, cross-sectional study on HIV-infected patients (pts) receiving unrestricted HAART and attending our clinic from January to May 2001. Pts completed a self-administered (ACTG modified) questionnaire on adherence to their therapy. Virologic response was defined as undetectable viral load at the time of interview. A regression model was used to determine predictors of adherence.

RESULTS

597 out of 623 pts (95.8%) completed the survey. Mean age was 38.2 years (range, 18-79). A total of 448 pts (75.0%) were men, 323 (54.1%) were intravenous drug users, 196 (32.8%) were heterosexuals, 76 (12.7%) were men who have sex with men. Mean time on therapy was 49.3 months (range, 4-145). All pts were on stable therapy (> 4 months), 173 pts (29%) were on their first HAART regimen, 309 pts (51.7%) were on NNRTI-based regimen, and 288 pts (48.2%) were on a PI-containing treatment. A total of 304 pts (50.9%) were categorized as adherent (p = .024). Multiple logistic regression showed that older age (p = .002), lower number of pills (p = .024), fewer daily doses (p = .002), and shorter time on therapy (p < .001) were factors associated with adherent behavior. Forgetfulness (59.3%), being away from home (50.2%), and problems with schedule (37.6%) were the most frequent causes of nonadherence. Adherent pts were more likely to have undetectable viral load than nonadherent pts (76.5% vs. 55.3%; p <.0001).

CONCLUSION

Younger age, higher number of pills, higher frequency of doses, and longer time on therapy were predictors of nonadherent behavior. Optimal adherence correlated with the best virologic response. Simpler regimens with a lower number of pills and doses may help patients' compliance to therapy.

摘要

背景

最佳地坚持高效抗逆转录病毒疗法（HAART）对于获得最佳和最持久的疗效是必要的。许多因素可能影响对如此严格治疗方案的依从性，识别这些因素可能有助于设计提高依从性的策略。

目的

评估与较低治疗依从性相关的因素、不依从的原因以及不依从与病毒学反应的关系。

方法

我们对2001年1月至5月在我们诊所接受无限制HAART治疗的HIV感染患者进行了一项观察性横断面研究。患者完成了一份关于治疗依从性的自我管理（ACTG修改版）问卷。病毒学反应定义为访谈时病毒载量不可检测。使用回归模型确定依从性的预测因素。

结果

623名患者中有597名（95.8%）完成了调查。平均年龄为38.2岁（范围18 - 79岁）。共有448名患者（75.0%）为男性，323名（54.1%）为静脉吸毒者，196名（32.8%）为异性恋者，76名（·12.7%）为男同性恋者。平均治疗时间为49.3个月（范围4 - 145个月）。所有患者均接受稳定治疗（>4个月），173名患者（29%）采用首个HAART方案，309名患者（51.7%）采用基于非核苷类逆转录酶抑制剂（NNRTI）的方案，288名患者（48.2%）采用含蛋白酶抑制剂（PI）的治疗。共有304名患者（50.9%）被归类为依从者（p = .024）。多因素logistic回归显示，年龄较大（p = .002）、药片数量较少（p = .024）、每日剂量较少（p = .002）以及治疗时间较短（p < .001）是与依从行为相关的因素。遗忘（59.3%）、离家外出（50.2%）和日程安排问题（37.6%）是最常见的不依从原因。依从患者比不依从患者更有可能病毒载量不可检测（76.5%对55.3%；p <.0001）。