Eldred L J, Wu A W, Chaisson R E, Moore R D
Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA.
J Acquir Immune Defic Syndr Hum Retrovirol. 1998 Jun 1;18(2):117-25. doi: 10.1097/00042560-199806010-00003.
Medication nonadherence in the treatment of chronic diseases compromises the effectiveness of therapy. Little information is available about the extent of medication adherence or determinants of medication adherence in HIV disease, an issue of increasing importance in this new therapeutic era of combination antiretroviral therapy.
We studied 244 HIV-infected Medicaid-insured patients attending an HIV hospital-based clinic regarding the extent of and predictors of adherence to antiretroviral therapy and Pneumocystis carinii pneumonia (PCP) prophylaxis. Patients were asked to report medications being taken, patterns of use, and knowledge and attitudes about HIV therapies. Medical record report of type, dose, and frequency of medication was compared with self-report using the kappa statistic. Urine sulfamethoxazole assay was obtained from patients prescribed sulfamethoxazole-trimethoprim.
Among patients prescribed antiretroviral therapy, 60% reported > or = 80% adherence in the previous 7 days; 49% reported > or = 80% adherence with PCP prophylaxis in the previous seven days. Seventy-nine percent of patients who reported taking daily sulfamethoxazole-trimethoprim had detectable urinary sulfamethoxazole. In multivariate analysis, > or = 80% adherence to antiretroviral therapy was associated with taking medication < or = twice a day (odds ratio [OR]=1.44; 95% confidence interval [CI], 1.01, 1.96), being likely to take medication when not at home, (OR=1.41; 95% CI, 1.04, 2.00) and patients' belief in their ability to adhere to therapy (OR=1.57; 95% CI, 1.13, 2.17). For PCP prophylaxis, > or = 80% adherence was associated with presence of family (OR=2.39; 95% CI, 1.01, 5.63) and patients' belief in their ability to adhere to therapy (OR=2.87; 95% CI, 1.44-1.78). Sociodemographic characteristics and belief in the efficacy of medications were not associated with adherence.
A relatively low level of adherence to antiretroviral therapy and PCP prophylactic regimens was found. Although our results are principally from patients receiving antiretroviral monotherapy, these findings may have important implications for patients receiving highly active antiretroviral therapy (HAART). Decreasing the complexity of antiretroviral regimens, and working with patients to modify identified barriers to adherence may improve effectiveness of medications and prolong survival.
慢性病治疗中的药物不依从性会影响治疗效果。在抗逆转录病毒联合治疗的新治疗时代，关于人类免疫缺陷病毒（HIV）疾病中药物依从性的程度或药物依从性的决定因素，目前所知甚少，而这一问题正变得日益重要。
我们研究了244名参加以医院为基础的HIV门诊的感染HIV且参加医疗补助计划的患者，了解他们对抗逆转录病毒治疗和卡氏肺孢子虫肺炎（PCP）预防的依从程度及预测因素。患者被要求报告所服用的药物、用药模式以及对HIV治疗的知识和态度。使用kappa统计量将病历报告的药物类型、剂量和用药频率与自我报告进行比较。对开具了磺胺甲恶唑 - 甲氧苄啶处方的患者进行尿磺胺甲恶唑检测。
在接受抗逆转录病毒治疗的患者中，60%报告在过去7天内依从性≥80%；49%报告在过去7天内对PCP预防的依从性≥80%。报告每日服用磺胺甲恶唑 - 甲氧苄啶的患者中，79%的尿磺胺甲恶唑检测呈阳性。在多变量分析中，抗逆转录病毒治疗依从性≥80%与每天服药≤2次相关（比值比[OR]=1.44；95%置信区间[CI]，1.01，1.96），不在家时也可能服药（OR=1.41；95%CI，1.04，2.00）以及患者对自己坚持治疗能力的信念（OR=1.57；95%CI，1.13，2.17）。对于PCP预防，依从性≥80%与有家人陪伴相关（OR=2.39；95%CI，1.01，5.63）以及患者对自己坚持治疗能力的信念（OR=2.87；95%CI，1.44 - 1.78）。社会人口统计学特征和对药物疗效的信念与依从性无关。
发现抗逆转录病毒治疗和PCP预防方案的依从性相对较低。尽管我们的结果主要来自接受抗逆转录病毒单药治疗的患者，但这些发现可能对接受高效抗逆转录病毒治疗（HAART）的患者具有重要意义。降低抗逆转录病毒治疗方案的复杂性，并与患者合作消除已确定的依从性障碍，可能会提高药物疗效并延长生存期。
