Arnsten Julia H, Li Xuan, Mizuno Yuko, Knowlton Amy R, Gourevitch Marc N, Handley Kathleen, Knight Kelly R, Metsch Lisa R
Division of General Internal Medicine, Albert Einstein College of Medicine and Montefiore Medical Center, Bronx, NY 10467, USA.
J Acquir Immune Defic Syndr. 2007 Nov 1;46 Suppl 2:S64-71. doi: 10.1097/QAI.0b013e31815767d6.
Active drug use is often associated with poor adherence, but few studies have determined psychosocial correlates of adherence in injection drug users (IDUs).
Of 1161 Intervention for Seropositive Injectors-Research and Evaluation study enrollees, 636 were taking antiretrovirals. We assessed self-reported adherence to self-reported antiretroviral regimens and medication errors, which we defined as daily doses that were inconsistent with standard or alternative antiretroviral prescriptions.
Most subjects (75%, n=477) self-reported good (>or=90%) adherence, which was strongly associated with an undetectable viral load. Good adherence was independently associated with being a high school graduate, not sharing injection equipment, fewer depressive symptoms, positive attitudes toward antiretrovirals, higher self-efficacy for taking antiretrovirals as prescribed, and greater sense of responsibility to protect others from HIV. Medication errors were made by 54% (n=346) and were strongly associated with a detectable viral load and fewer CD4 cells. Errors were independently associated with nonwhite race and with depressive symptoms, poorer self-efficacy for safer drug use, and worse attitudes toward HIV medications.
Modifiable factors associated with poor adherence, including depressive symptoms and poor self-efficacy, should be targeted for intervention. Because medication errors are prevalent and associated with a detectable viral load and fewer CD4 cells, interventions should include particular efforts to identify medication taking inconsistent with antiretroviral prescriptions.
使用活性药物往往与依从性差相关，但很少有研究确定注射吸毒者（IDU）依从性的社会心理相关因素。
在1161名血清反应阳性注射者干预研究与评估的参与者中，636人正在服用抗逆转录病毒药物。我们评估了自我报告的对抗逆转录病毒治疗方案的依从性以及用药错误情况，我们将用药错误定义为与标准或替代抗逆转录病毒药物处方不一致的每日剂量。
大多数受试者（75%，n = 477）自我报告依从性良好（≥90%），这与病毒载量不可检测密切相关。良好的依从性独立地与高中毕业、不共用注射设备、抑郁症状较少、对抗逆转录病毒药物持积极态度、按规定服用抗逆转录病毒药物的自我效能感较高以及保护他人免受艾滋病毒感染的责任感较强相关。54%（n = 346）的人出现用药错误，这与可检测到的病毒载量和较少的CD4细胞密切相关。错误独立地与非白人种族、抑郁症状、安全用药的自我效能感较差以及对艾滋病毒药物的态度较差相关。
与依从性差相关的可改变因素，包括抑郁症状和自我效能感差，应作为干预目标。由于用药错误很普遍，且与可检测到的病毒载量和较少的CD4细胞相关，干预措施应特别努力识别与抗逆转录病毒药物处方不一致的用药情况。
