Bonolo Palmira de F, César Cibele C, Acúrcio Francisco A, Ceccato Maria das Graças B, de Pádua Cristiane A Menezes, Alvares Juliana, Campos Lorenza N, Carmo Ricardo A, Guimarães Mark D C
Department of Preventive and Social Medicine, Institute of Exact Sciences, Federal University of Minas Gerais (UFMG), Belo Horizonte, MG, Brazil.
AIDS. 2005 Oct;19 Suppl 4:S5-13. doi: 10.1097/01.aids.0000191484.84661.2b.
To assess the incidence, magnitude and factors associated with the first episode of non-adherence for 12 months after the first antiretroviral prescription.
A prospective study of HIV-infected patients receiving their first antiretroviral prescription in public referral centers, Belo Horizonte, Brazil. Baseline assessment occurred at the moment of the first prescription and follow-up visits at the first, fourth and seventh month, from May 2001 to May 2003.
Non-adherence was self-reported and defined as the intake of less than 95% of the prescribed doses for 3 days before the follow-up interviews. Cumulative and person-time incidence were estimated and Cox's proportional model was used to assess the relative hazard (RH) of non-adherence with 95% confidence interval for both univariate and multivariate analysis.
Among 306 patients, the cumulative incidence of non-adherence was 36.9% (incidence rate 0.21/100 person-days). Multivariate analysis (P < 0.05) showed that unemployment (RH = 2.17), alcohol use (RH = 2.27), self-report of three or more adverse reactions (RH = 1.64), number of pills per day (RH = 2.04), switch in antiretroviral regimen (RH = 2.72), and a longer time between the HIV test result and the first antiretroviral prescription (RH = 2.27) were associated with an increased risk of non-adherence, whereas the use of more than one health service indicated a negative association (RH = 0.54).
The current analysis has pointed out the importance of clinical and health service characteristics as potential indicators of non-adherence after initiating therapy. Early assessment and intervention strategies should be priorities in these AIDS public referral centres. Feasible and reliable indicators for the routine monitoring of adherence should be incorporated in clinical practice.
评估首次接受抗逆转录病毒治疗处方后12个月内首次出现不依从情况的发生率、程度及相关因素。
对在巴西贝洛奥里藏特的公共转诊中心首次接受抗逆转录病毒治疗处方的HIV感染患者进行的一项前瞻性研究。2001年5月至2003年5月期间，在首次处方时进行基线评估，并在第1、4和7个月进行随访。
不依从情况通过自我报告确定，定义为在随访访谈前3天内服用的规定剂量少于95%。估计累积发病率和人时发病率，并使用Cox比例模型评估不依从的相对风险（RH），95%置信区间用于单变量和多变量分析。
在306例患者中，不依从的累积发病率为36.9%（发病率为0.21/100人日）。多变量分析（P<0.05）显示，失业（RH=2.17）、饮酒（RH=2.27）、自我报告有三种或更多不良反应（RH=1.64）、每日服药片数（RH=2.04）、抗逆转录病毒治疗方案的更换（RH=2.72）以及HIV检测结果与首次抗逆转录病毒治疗处方之间的时间间隔较长（RH=2.27）与不依从风险增加相关，而使用多个医疗服务机构则显示出负相关（RH=0.54）。
当前分析指出了临床和医疗服务特征作为治疗开始后不依从潜在指标的重要性。早期评估和干预策略应成为这些艾滋病公共转诊中心的优先事项。临床实践中应纳入可行且可靠的依从性常规监测指标。
