Kalichman Seth C, Grebler Tamar, Amaral Christina M, McNerney Megan, White Denise, Kalichman Moira O, Cherry Chauncey, Eaton Lisa
Department of Psychology, University of Connecticut, 406 Babbidge Road, Storrs, CT, 06269, USA,
Int J Behav Med. 2014;21(5):811-20. doi: 10.1007/s12529-013-9353-7.
Substance use is a known predictor of poor adherence to antiretroviral therapies (ART) in people living with human immunodeficiency virus (HIV)/acquired immunodeficiency syndrome. Less studied is the association between substance use and treatment outcomes, namely, suppression of HIV replication.
Adults living with HIV (N = 183) who reported alcohol use in the previous week and receiving ART were observed over a 12-month period. Participants completed computer interviews, monthly unannounced pill counts to monitor ART adherence, and daily cell-phone delivered interactive-text assessments for alcohol use. HIV viral load was collected at baseline and 12-month follow-up from medical records. Analyses compared participants who had undetectable HIV viral loads at baseline and follow-up (sustained viral suppression) to those with unsustained viral suppression. Analyses also compared participants who were adherent to their medications (>85 % pills taken) over the year of observation to those who were nonadherent.
Fifty-two percent of participants had unsustained viral suppression; 47 % were ART nonadherent. Overall results failed to demonstrate alcohol use as a correlate of sustained viral suppression or treatment adherence. However, alcohol use was associated with nonadherence among participants who did not have sustained viral suppression; nonadherence in unsustained viral suppression patients was related to drinking on fewer days of assessment, missing medications when drinking, and drinking socially.
Poor HIV treatment outcomes and nonadherence were prevalent among adults treated for HIV infection who drink alcohol. Drinking in relation to missed medications and drinking in social settings are targets for interventions among alcohol drinkers at greatest risk for poor treatment outcomes.
物质使用是已知的人类免疫缺陷病毒（HIV）/获得性免疫缺陷综合征患者抗逆转录病毒疗法（ART）依从性差的预测因素。物质使用与治疗结果（即HIV复制抑制）之间的关联研究较少。
对183名报告前一周饮酒且正在接受ART治疗的HIV成年患者进行了为期12个月的观察。参与者完成了计算机访谈、每月一次的不通知药丸计数以监测ART依从性，以及通过手机进行的每日酒精使用交互式文本评估。从医疗记录中收集基线和12个月随访时的HIV病毒载量。分析比较了在基线和随访时HIV病毒载量不可检测（持续病毒抑制）的参与者与病毒抑制未持续的参与者。分析还比较了在观察期内服药依从性>85%的参与者与不依从的参与者。
52%的参与者病毒抑制未持续；47%的参与者ART不依从。总体结果未能证明酒精使用与持续病毒抑制或治疗依从性相关。然而，酒精使用与病毒抑制未持续的参与者的不依从相关；病毒抑制未持续患者的不依从与评估期间饮酒天数较少、饮酒时漏服药物以及社交饮酒有关。
在接受HIV感染治疗的饮酒成年患者中，HIV治疗效果不佳和不依从情况普遍存在。与漏服药物相关的饮酒以及社交场合饮酒是治疗效果不佳风险最高的饮酒者干预的目标。
