Deschamps Ann E, Graeve Veerle D E, van Wijngaerden Eric, De Saar Veerle, Vandamme Anne-Mieke, van Vaerenbergh Kristien, Ceunen Helga, Bobbaers Herman, Peetermans Willy E, de Vleeschouwer Peter J, de Geest Sabina
University Hospitals KU-Leuven, Department of Internal Medicine, Leuven, Belgium.
AIDS Patient Care STDS. 2004 Nov;18(11):644-57. doi: 10.1089/apc.2004.18.644.
Nonadherence to antiretroviral therapy (ART) jeopardizes good clinical outcome in people living with HIV. In a single-center prospective study, prevalence and correlates of nonadherence were investigated in 43 patients on ART. Nonadherence was assessed using Medication Event Monitoring System (MEMS), self-report and collateral report of treating physicians. Based on MEMS data, median taking adherence, dosing adherence, and timing adherence was 98% (interquartile range [IQR] = 5.3), 91.5% (IQR = 18), and 86% (IQR = 31.5), respectively. The median number of drug holidays per 100 days was 0.8 (IQR = 4.8). The prevalence of nonadherence measured by MEMS was 40%. Self-reported nonadherence and collateral report of nonadherence by physicians varied from 5% to 41% and 24% to 28%, respectively. Patients were categorized as adherent or nonadherent based on a clinically validated algorithm derived from MEMS parameters. Nonadherent patients used significantly more escaping coping strategies (p = 0.003) and planned problem solving strategies (p = 0.049), were prescribed significantly more antiretroviral medications (p = 0.02) and were significantly longer on ART (p = 0.04) than adherent patients. Identified correlates of nonadherence may help clinicians in detecting patients with HIV at risk for nonadherence and can support the development of adherence enhancing interventions.
不坚持抗逆转录病毒疗法（ART）会危及HIV感染者的良好临床结局。在一项单中心前瞻性研究中，对43名接受ART治疗的患者的不坚持治疗的患病率及其相关因素进行了调查。使用药物事件监测系统（MEMS）、自我报告以及治疗医生的旁证报告来评估不坚持治疗的情况。根据MEMS数据，服药依从性、剂量依从性和时间依从性的中位数分别为98%（四分位间距[IQR]=5.3）、91.5%（IQR=18）和86%（IQR=31.5）。每100天的停药天数中位数为0.8（IQR=4.8）。通过MEMS测得的不坚持治疗的患病率为40%。自我报告的不坚持治疗情况以及医生报告的不坚持治疗旁证情况分别在5%至41%和24%至28%之间。根据从MEMS参数得出的经过临床验证的算法，将患者分为坚持治疗组或不坚持治疗组。与坚持治疗的患者相比，不坚持治疗的患者显著更多地使用逃避应对策略（p=0.003）和计划性问题解决策略（p=0.049），服用的抗逆转录病毒药物显著更多（p=0.02），且接受ART治疗的时间显著更长（p=0.04）。确定的不坚持治疗的相关因素可能有助于临床医生检测有不坚持治疗风险的HIV患者，并可支持制定增强依从性的干预措施。
