Pádua C A Menezes de, César C C, Bonolo P F, Acurcio F A, Guimarães M D C
Departamento de Medicina Preventiva e Social, Faculdade de Medicina, Universidade Federal de Minas Gerais, Belo Horizonte, MG, Brazil.
Braz J Med Biol Res. 2006 Apr;39(4):495-505. doi: 10.1590/s0100-879x2006000400010. Epub 2006 Apr 3.
A concurrent prospective study was conducted from 2001 to 2003 to assess factors associated with adverse reactions among individuals initiating antiretroviral therapy at two public referral HIV/AIDS centers in Belo Horizonte, MG, Brazil. Adverse reactions were obtained from medical charts reviewed up to 12 months after the first antiretroviral prescription. Cox proportional hazard model was used to perform univariate and multivariate analyses. Relative hazards (RH) were estimated with 95% confidence intervals (CI). Among 397 charts reviewed, 377 (95.0%) had precise information on adverse reactions and initial antiretroviral treatment. Most patients received triple combination regimens including nucleoside reverse transcriptase inhibitors, non-nucleoside reverse transcriptase inhibitors and protease inhibitors. At least one adverse reaction was recorded on 34.5% (N = 130) of the medical charts (0.17 adverse reactions/100 person-day), while nausea (14.5%) and vomiting (13.1%) were the most common ones. Variables independently associated with adverse reactions were: regimens with nevirapine (RH = 1.78; 95% CI = 1.07-2.96), indinavir or indinavir/ritonavir combinations (RH = 2.05; 95% CI = 1.15-3.64), female patients (RH = 1.93; 95% CI = 1.31-2.83), 5 or more outpatient visits (RH = 1.94; 95% CI = 1.25-3.01), non-adherence to antiretroviral therapy (RH = 2.38; 95% CI = 1.62-3.51), and a CD4+ count of 200 to 500 cells/mm3 (RH = 2.66; 95% CI = 1.19-5.90). An independent and negative association was also found for alcohol use (RH = 0.55; 95% CI = 0.33-0.90). Adverse reactions were substantial among participants initiating antiretroviral therapy. Specially elaborated protocols in HIV/AIDS referral centers may improve the diagnosis, management and prevention of adverse reactions, thus contributing to improving adherence to antiretroviral therapy among HIV-infected patients.
2001年至2003年开展了一项同期前瞻性研究，以评估巴西米纳斯吉拉斯州贝洛奥里藏特市两家公共转诊艾滋病毒/艾滋病中心开始抗逆转录病毒治疗的个体中与不良反应相关的因素。不良反应信息来自首次开具抗逆转录病毒药物处方后长达12个月的病历审查。采用Cox比例风险模型进行单因素和多因素分析。估计相对风险（RH）及95%置信区间（CI）。在审查的397份病历中，377份（95.0%）有关于不良反应和初始抗逆转录病毒治疗的准确信息。大多数患者接受三联联合治疗方案，包括核苷类逆转录酶抑制剂、非核苷类逆转录酶抑制剂和蛋白酶抑制剂。34.5%（N = 130）的病历记录了至少一种不良反应（0.17次不良反应/100人日），其中恶心（14.5%）和呕吐（13.1%）最为常见。与不良反应独立相关的变量有：含奈韦拉平的治疗方案（RH = 1.78；95%CI = 1.07 - 2.96）、茚地那韦或茚地那韦/利托那韦联合治疗方案（RH = 2.05；95%CI = 1.15 - 3.64）、女性患者（RH = 1.93；95%CI = 1.31 - 2.83）、门诊就诊5次或更多（RH = 1.94；95%CI = 1.25 - 3.01）、抗逆转录病毒治疗依从性差（RH = 2.38；95%CI = 1.62 - 3.51）以及CD4 +细胞计数为200至500个/mm³（RH = 2,66；95%CI = 1.19 - 5.90）。还发现饮酒与之存在独立的负相关（RH = 0.55；95%CI = 0.33 - 0.90）。开始抗逆转录病毒治疗的参与者中不良反应较为严重。艾滋病毒/艾滋病转诊中心专门制定的方案可能会改善不良反应的诊断、管理和预防，从而有助于提高艾滋病毒感染患者对抗逆转录病毒治疗的依从性。
