Teixeira Celia, Dourado Maria De Lourdes, Santos Marcio P, Brites Carlos
CEDAP-Centro Especializado em Diagnóstico, Assistência e Pesquisa, Salvador, Brazil.
AIDS Res Hum Retroviruses. 2013 May;29(5):799-804. doi: 10.1089/aid.2012.0296. Epub 2013 Feb 5.
Use of alcohol and illicit drugs is a common finding among HIV-infected individuals, but there are many open questions about its impact on adherence to antiretroviral therapy and virological outcomes. Our study aimed to evaluate the impact of the use of alcohol and illicit drugs on the adherence to antiretroviral therapy (ART) among patients starting ART in Salvador, Brazil. We followed up 144 AIDS patients initiating ART for a 6-month period. At baseline, they were interviewed about demographics, behavior, and use of illicit drugs and alcohol. All of them had HIV-1 RNA plasma viral load and CD4(+)/CD8(+) cells count measured before starting therapy. After 60 days of treatment they were asked to answer a new questionnaire on adherence to ART. All patients were monitored during the following months, and new CD4(+) cell count/HIV-1 RNA plasma viral load determinations were performed after 6 months of therapy. Optimal adherence to therapy was defined by self-reported questionnaire, by 95% use of prescribed drug doses, and by using plasma HIV-1 RNA viral load as a biological marker. A total of 61 (42.4%) patients reported alcohol use, 7 (4.9%) used illicit drugs, and 17 (11.8%) used both alcohol and illicit drugs. Being in a steady relationship was protective to nonadherence (95% CI: 0.18-0.84). Missing more than two medical visits was also associated with a 68% higher likelihood of nonadherence (95% CI: 0.10-1.02). After logistic regression we detected a higher risk of nonadherence for patients declaring use of alcohol plus illicit drugs (odds ratio=6.0; 95% CI: 1.78-20.28) or high-intensity use of alcohol (odds ratio=3.29; 95% CI: 1.83-5.92). AIDS patients using alcohol and/or illicit drugs are socially vulnerable, and need specific and flexible programs, combining mental health care, harm reduction strategies, and assisted drug therapy to maximize the chances of successful use of ART.
在感染艾滋病毒的个体中，饮酒和使用非法药物是常见现象，但关于其对抗逆转录病毒治疗依从性和病毒学结果的影响仍存在许多未解决的问题。我们的研究旨在评估在巴西萨尔瓦多开始接受抗逆转录病毒治疗（ART）的患者中，饮酒和使用非法药物对ART依从性的影响。我们对144名开始接受ART的艾滋病患者进行了为期6个月的随访。在基线时，对他们进行了关于人口统计学、行为以及非法药物和酒精使用情况的访谈。所有患者在开始治疗前均检测了HIV-1 RNA血浆病毒载量和CD4(+)/CD8(+)细胞计数。治疗60天后，要求他们回答一份关于ART依从性的新问卷。在接下来的几个月里对所有患者进行监测，并在治疗6个月后进行新的CD4(+)细胞计数/HIV-1 RNA血浆病毒载量测定。通过自我报告问卷、95%的规定药物剂量使用情况以及将血浆HIV-1 RNA病毒载量作为生物学标志物来定义最佳治疗依从性。共有61名（42.4%）患者报告饮酒，7名（4.9%）使用非法药物，17名（11.8%）既饮酒又使用非法药物。处于稳定关系对不依从具有保护作用（95%置信区间：0.18 - 0.84）。错过超过两次就诊也与不依从的可能性高68%相关（95%置信区间：0.10 - 1.02）。经过逻辑回归分析，我们发现宣称使用酒精加非法药物（比值比 = 6.0；95%置信区间：1.78 - 20.28）或高强度饮酒（比值比 = 3.29；95%置信区间：1.83 - 5.92）的患者不依从风险更高。使用酒精和/或非法药物的艾滋病患者在社会上处于弱势地位，需要特定且灵活的项目，将精神卫生保健、减少伤害策略和辅助药物治疗相结合，以最大限度地提高成功使用ART的机会。
