Weber Rainer, Christen Lisanne, Christen Stephan, Tschopp Simone, Znoj Hansjoerg, Schneider Christine, Schmitt Joachim, Opravil Milos, Günthard Huldrych F, Ledergerber Bruno
Division of Infectious Diseases and Hospital Epidemiology, University Hospital, Zurich, Switzerland.
Antivir Ther. 2004 Feb;9(1):85-95.
A high level of adherence to antiretroviral therapy is required for complete suppression of HIV replication, immunological and clinical effectiveness. We investigated whether cognitive behaviour therapy can improve medication adherence.
Prospective randomized 1-year trial.
Collaboration of HIV university outpatient clinic and psychotherapists in private practice.
60 HIV-infected persons on stable antiretroviral combination therapy and viral load below 50 copies/ml.
Cognitive behaviour intervention in individual patients, in addition to standard of care.
Feasibility and acceptance of intervention; adherence to therapy assessed using medication event monitoring system (MEMS) and self-report questionnaire; virological failure; psychosocial measures.
The median number of sessions for cognitive behaviour intervention per patient during the 1-year trial was 11 (range 2-25). At months 10-12, mean adherence to therapy as assessed using MEMS was 92.8% in the intervention and 88.9% in the control group (P=0.2); the proportion of patients with adherence > or = 95% was 70 and 50.0% (P=0.014), respectively. While there was no significant deterioration of adherence during the study in the intervention arm, adherence decreased by 8.7% per year (P=0.006) in the control arm. No differences between the intervention group and standard of care group were found regarding virological outcome. Compared with the control group, participants in the intervention group perceived a significant improvement of their mental health during the study period.
Cognitive behavioural support in addition to standard of care of HIV-infected persons is feasible in routine practice, and can improve medication adherence and mental health.
为了完全抑制HIV复制、实现免疫和临床疗效，需要高度坚持抗逆转录病毒治疗。我们调查了认知行为疗法是否能提高药物依从性。
前瞻性随机1年试验。
HIV大学门诊诊所与私人执业心理治疗师的合作。
60名接受稳定抗逆转录病毒联合治疗且病毒载量低于50拷贝/毫升的HIV感染者。
除标准治疗外，对个体患者进行认知行为干预。
干预的可行性和可接受性；使用药物事件监测系统（MEMS）和自我报告问卷评估的治疗依从性；病毒学失败；心理社会指标。
在1年试验期间，每位患者接受认知行为干预的疗程中位数为11次（范围2 - 25次）。在第10 - 12个月时，使用MEMS评估的干预组平均治疗依从性为92.8%，对照组为88.9%（P = 0.2）；依从性≥95%的患者比例分别为70%和50.0%（P = 0.014）。虽然干预组在研究期间依从性没有显著下降，但对照组的依从性每年下降8.7%（P = 0.006）。在病毒学结果方面，干预组与标准治疗组之间未发现差异。与对照组相比，干预组参与者在研究期间感觉心理健康有显著改善。
在HIV感染者的标准治疗基础上提供认知行为支持在常规实践中是可行的，并且可以提高药物依从性和心理健康水平。
