Waldrop-Valverde Drenna, Valverde Eduardo
Department of Psychiatry & Behavioral Sciences, University of Miami School of Medicine, Miami, Florida 33101, USA.
AIDS Patient Care STDS. 2005 May;19(5):326-34. doi: 10.1089/apc.2005.19.326.
High levels of adherence to antiretroviral medications are required to maximize therapeutic benefits and viral suppression. Injecting drug use (IDU) is associated with decreased adherence levels, unstable living conditions and mental health problems. Despite the prevalence of these nonadherence risks in HIV-positive IDUs, little study has been conducted to date to assess the impact of homelessness and psychological distress on adherence in this population. The present study evaluated the effects of housing status (homeless/marginally housed versus nonhomeless) and psychological distress, measured via depression, anxiety and perceived stress, on self-reported adherence in 58 HIV-positive IDUs. Results from this study indicated that homeless/marginally housed HIV-positive IDUs reported higher levels of anxiety and perceived stress than their nonhomeless counterparts. The groups reported similar levels of depression. However, only depression was significantly related to adherence. Housing status, drug or alcohol use, and other demographic variables including gender, race/ethnicity, and years of education, were not associated with adherence. This study also found a relatively high rate of adherence in homeless/marginally housed IDUs with more than half (63%) reporting perfect (100%) adherence levels. Findings from this study suggest that when evaluating patient readiness for antiretroviral medications, current housing may not need to be the primary concern. Rather, depression may be a more potent indicator of nonadherence than homelessness for HIV-positive IDUs.
为了使治疗效果和病毒抑制最大化，需要高度坚持抗逆转录病毒药物治疗。注射吸毒与坚持治疗水平下降、生活条件不稳定以及心理健康问题相关。尽管在艾滋病毒呈阳性的注射吸毒者中这些不坚持治疗的风险普遍存在，但迄今为止，几乎没有研究评估无家可归和心理困扰对该人群坚持治疗的影响。本研究评估了住房状况（无家可归/勉强有住处与有固定住所）以及通过抑郁、焦虑和感知压力来衡量的心理困扰对58名艾滋病毒呈阳性的注射吸毒者自我报告的坚持治疗情况的影响。该研究结果表明，无家可归/勉强有住处的艾滋病毒呈阳性注射吸毒者报告的焦虑和感知压力水平高于有固定住所的同龄人。两组报告的抑郁水平相似。然而，只有抑郁与坚持治疗显著相关。住房状况、药物或酒精使用以及包括性别、种族/族裔和受教育年限在内的其他人口统计学变量与坚持治疗无关。本研究还发现，在无家可归/勉强有住处的注射吸毒者中，坚持治疗率相对较高，超过一半（63%）的人报告坚持治疗水平完美（100%）。该研究结果表明，在评估患者对抗逆转录病毒药物治疗的准备情况时，当前的住房状况可能无需作为主要关注点。相反，对于艾滋病毒呈阳性的注射吸毒者而言，抑郁可能比无家可归更能有力地表明其不坚持治疗的情况。
