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[Factors predicting lack of adherence to highly active antiretroviral treatment]
Vicente Martín-Sánchez1, Luis Ortega-Valín, María del Rosario Pérez-Simón
1Area de Medicina Preventiva y Salud Pública. Departamento de Fisiología. Universidad de León. León. Spain.
Insights
Over half of HIV patients on highly active antiretroviral treatment (HAART) showed poor adherence. Cocaine use and lack of clarity on medication regimens were key factors linked to non-compliance.
Area of Science:
- Infectious Diseases
- Pharmacology
- Public Health
Context:
- HIV/AIDS management requires consistent adherence to highly active antiretroviral treatment (HAART).
- Understanding factors influencing HAART adherence is crucial for effective patient follow-up.
- Previous studies have identified various predictors of non-adherence in HIV-infected populations.
Purpose:
- To assess the level of adherence to HAART among HIV-infected patients.
- To identify variables associated with poor treatment adherence in this population.
- To inform targeted interventions for improving HAART compliance.
Summary:
- A study of 206 HIV patients found over half (52.4%) were non-adherent to HAART.
- Multivariate analysis identified cocaine use (OR 5.1), uncertainty about medication use (OR 2.5), and not being prescribed zidovudine-lamivudine (OR 1.9) as significant predictors of non-adherence.
- Methodological challenges in measuring adherence were noted, with over a third of patients without identified risk factors still considered non-compliant.
Impact:
- Findings highlight the significant challenge of HAART adherence in HIV care.
- Identified risk factors provide targets for clinical interventions to improve medication adherence.
- Results underscore the need for comprehensive patient support addressing social, psychological, and healthcare factors to enhance treatment outcomes.
Introduction:
Knowledge of adherence to highly active antiretroviral treatment (HAART) and the variables associated with poor compliance is useful for the follow-up of HIV infected patients.
Patients, Material And Methods:
Patients were consecutively recruited from the HIV outpatient clinics of the Hospitals of Leon and El Bierzo from January to June 2000. Patients were considered non-adherent to treatment if they failed to take 10% or more of their prescribed total dose of at least one drug during the 4 days before the interview, or if they had accumulated a delay of more than 9 days over the previous 3 months in picking up their prescribed drugs from the hospital pharmacy. Logistic regression analysis was performed with variables found to be associated with adherence in the univariate analysis.
Results:
The methods used to determine adherence had a Kappa index of 12.6%. Among the 206 patients interviewed, 108 were considered non-adherent (52.4%; CI 95% 5 45.6-59.2). Multivariate analysis showed that the following factors were associated with poor treatment adherence: cocaine consumption in the previous six months (adjusted OR 5 5.1); patients unsure about the proper way to take prescribed treatment; (adjusted OR 5 2.5); and patients not prescribed the zidovudine-lamivudine combination (adjusted OR 5 1.9). Over one-third of patients with no variable associated with treatment adherence were considered non-compliant.
Conclusion:
Measurement of medication adherence and its predictive factors involved methodological difficulties. With the criteria used in the present study more than half the patients were considered non-compliant. The variables found to be related to poor adherence can be modified by social, psychological or health care interventions.