Fumaz C R, Muñoz-Moreno J A, Moltó J, Ferrer M J, López-Blázquez R, Negredo E, Paredes R, Gómez G, Clotet B
Lluita contra la SIDA Foundation, Barcelona, Spain.
AIDS Care. 2008 Aug;20(7):796-805. doi: 10.1080/09540120701694022.
The objective of this study was to assess adherence of HIV-1-infected patients who started treatment in the pre-HAART era and to determine variables associated with better adherence, including relevant attitudes and beliefs. This is a cross-sectional study enrolling patients who had received antiretroviral therapy for >or=10 years. Adherence was evaluated through self-reporting and plasma drug concentrations. Treatment variables, attitudes and beliefs were collected during structured interviews. The results show that for 87 patients the median (interquartile range) time on therapy was 13 (10-19) years; 80 were on therapy at the time of analysis. Adherence was >or=95% in 54 patients (67.5%), 90-94% in 22 (27.5%) and <90% in 4 (5%). Drug concentrations were below the lower limit of detection in five patients. Younger age (p=0.014), female gender (p=0.005), current substance abuse (p=0.004) and hepatitis C virus co-infection (p<0.001) were related to lower adherence. Adherence did not differ in relation to different drug families or once- or twice-daily regimens. Patients with adherence <95% were more likely to have interrupted treatment without doctor's recommendation (p=0.009). Adherent patients exhibited a higher perception of risk of developing the illness and of benefits of therapy, higher self-efficacy and intention to adhere and were more influenced by events that motivate medication intake. To conclude, adherence was >90% in most patients on antiretroviral therapy for >or=10 years. Adherence was more related to beliefs about health and illness than to the characteristics of medication or level of knowledge about treatment. Care adherence interventions should include assessment of health beliefs.
本研究的目的是评估在高效抗逆转录病毒治疗（HAART）时代之前开始治疗的HIV-1感染患者的依从性，并确定与更好依从性相关的变量，包括相关态度和信念。这是一项横断面研究，纳入接受抗逆转录病毒治疗≥10年的患者。通过自我报告和血浆药物浓度评估依从性。在结构化访谈期间收集治疗变量、态度和信念。结果显示，87例患者的治疗中位时间（四分位间距）为13（10 - 19）年；分析时80例患者正在接受治疗。54例患者（67.5%）的依从性≥95%，22例（27.5%）为90 - 94%，4例（5%）<90%。5例患者的药物浓度低于检测下限。年龄较小（p = 0.014）、女性（p = 0.005）、当前药物滥用（p = 0.004）和丙型肝炎病毒合并感染（p < 0.001）与较低的依从性相关。依从性在不同药物类别或每日一次或两次给药方案方面无差异。依从性<95%的患者更有可能在没有医生建议的情况下中断治疗（p = 0.009）。依从性好的患者对患病风险和治疗益处的认知更高，自我效能感和依从意愿更高，并且更受促使服药的事件影响。总之，大多数接受抗逆转录病毒治疗≥10年的患者依从性>90%。依从性与对健康和疾病的信念比与药物特性或治疗知识水平的关系更大。护理依从性干预应包括对健康信念的评估。
