Michigan State University, International Neurologic and Psychiatric Epidemiology Program, East Lansing, Michigan, USA.
Am J Trop Med Hyg. 2011 Oct;85(4):782-9. doi: 10.4269/ajtmh.2011.11-0187.
We conducted a prospective cohort study of 496 adults starting antiretroviral treatment (ART) to determine the impact of neuropsychiatric symptoms and socioeconomic status on adherence and mortality. Almost 60% had good adherence based upon pharmacy records. Poor adherence was associated with being divorced, poorer, food insecure, and less educated. Longer travel time to clinic, concealing one's human immunodeficiency virus (HIV) status, and experiencing side effects predicted poor adherence. Over a third of the patients had cognitive impairment and poorer cognitive function was also associated with poor adherence. During follow-up (mean 275 days), 20% died-usually within 90 days of starting ART. Neuropsychiatric symptoms, advanced HIV, peripheral neuropathy symptoms, food insecurity, and poverty were associated with death. Neuropsychiatric symptoms, advanced HIV, and poverty remained significant independent predictors of death in a multivariate model adjusting for other significant factors. Social, economic, cognitive, and psychiatric problems impact adherence and survival for people receiving ART in rural Zambia.
我们进行了一项针对 496 名开始接受抗逆转录病毒治疗 (ART) 的成年人的前瞻性队列研究，以确定神经精神症状和社会经济状况对依从性和死亡率的影响。近 60%的人根据药房记录显示依从性良好。较差的依从性与离婚、贫困、食物不安全和受教育程度较低有关。到诊所的旅行时间较长、隐瞒艾滋病毒 (HIV) 状况以及出现副作用都预示着较差的依从性。超过三分之一的患者存在认知障碍，认知功能较差也与依从性差有关。在随访期间（平均 275 天），20%的患者死亡——通常在开始接受 ART 后 90 天内。神经精神症状、晚期 HIV、周围神经病症状、食物不安全和贫困与死亡相关。在调整其他重要因素后，多变量模型显示，神经精神症状、晚期 HIV 和贫困仍然是死亡的独立重要预测因素。在赞比亚农村地区，社会、经济、认知和精神问题影响接受 ART 治疗的人的依从性和生存。
