Paydary Koosha, Ekhtiari Hamed, Noori Mehri, Rad Mona V, Hajiabdolbaghi Mahboubeh, SeyedAlinaghi SeyedAhmad
Iranian Research Center for HIV/AIDS (IRCHA), Imam Khomeini Hospital, Keshavarz Blvd, Tehran, Iran.
Infect Disord Drug Targets. 2015;15(3):177-83. doi: 10.2174/1871526515666150928115103.
Adequate adherence to anti-retroviral therapy is required to achieve viral suppression and desirable treatment outcomes among HIV patients. The aim of this study was to examine the associations between adherence and severity of substance use as well as adherence and severity of depressive symptoms among Iranian HIV patients. In a prospective study, HIV patients with current substance use were assessed for adherence level via self report and pill count methods, severity of depressive symptoms (Beck Depression Inventory- II) and substance use (Addiction Severity Index) during a three months follow up after initiating antiretroviral therapy. The adherence level, severity of depressive symptoms and substance use were assessed one month, two months and three months after initiation of anti-retroviral therapy. Addiction Severity Index (ASI) composite scores were calculated for each domain and the associations between ASI domains and adherence as well as severity of depressive symptoms and adherence were assessed. Twenty six HIV patients with current substance use disorder completed the study. At the end of the first month, adherence to therapy via pill count and self-report were 80%±31.9% and 85.12%±32%, respectively. At the end of the second month, adherence to therapy via pill count and self report were 87%±32% and 93.94%±23% respectively. At the end of the third month, the measured adherence via pill count and self report were 85%±33.7% and 90.1%±25.7% respectively. Adherence was higher among married patients and those who used reminder systems. Composite scores of the medical status and psychiatric status were related to higher adherence after first month. Substance use was inversely associated with adherence at the second follow up (r=-0.4, p=0.04). Also, severity of depressive symptoms was not related to adherence level. The repeated measurement analysis showed a significant decrease in psychiatric status domain of the ASI composite score after three months of initiating therapy (p=0.02). Preventive measures should aim treatment of substance use among HIV patients in order to increase adherence level. Also, conducting psychological evaluations is necessary considering the high prevalence of depression among Iranian HIV patients.
为了在艾滋病毒患者中实现病毒抑制和理想的治疗效果，需要充分坚持抗逆转录病毒疗法。本研究的目的是调查伊朗艾滋病毒患者中依从性与物质使用严重程度之间以及依从性与抑郁症状严重程度之间的关联。在一项前瞻性研究中，对目前有物质使用问题的艾滋病毒患者在开始抗逆转录病毒治疗后的三个月随访期间，通过自我报告和药丸计数方法评估其依从水平、抑郁症状严重程度（贝克抑郁量表-II）和物质使用情况（成瘾严重程度指数）。在开始抗逆转录病毒治疗后的1个月、2个月和3个月评估依从水平、抑郁症状严重程度和物质使用情况。计算每个领域的成瘾严重程度指数（ASI）综合得分，并评估ASI领域与依从性之间以及抑郁症状严重程度与依从性之间的关联。26名目前患有物质使用障碍的艾滋病毒患者完成了该研究。在第一个月末，通过药丸计数和自我报告的治疗依从率分别为80%±31.9%和85.12%±32%。在第二个月末，通过药丸计数和自我报告的治疗依从率分别为87%±32%和93.94%±23%。在第三个月末，通过药丸计数和自我报告测得的依从率分别为85%±33.7%和90.1%±25.7%。已婚患者和使用提醒系统的患者依从性更高。第一个月后，医疗状况和精神状况的综合得分与更高的依从性相关。在第二次随访时，物质使用与依从性呈负相关（r=-0.4，p=0.04）。此外，抑郁症状的严重程度与依从水平无关。重复测量分析显示，开始治疗三个月后，ASI综合得分的精神状况领域显著下降（p=0.02）。预防措施应旨在治疗艾滋病毒患者的物质使用问题，以提高依从水平。此外，鉴于伊朗艾滋病毒患者中抑郁症的高患病率，进行心理评估是必要的。
