Determinants of compliance with antiretroviral therapy in patients with human immunodeficiency virus: Prospective assessment with implications for enhancing compliance
Determinants of compliance with antiretroviral therapy in patients with human immunodeficiency virus: Prospective assessment with implications for enhancing compliance
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DOI：
10.1080/09540129650125696
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发表时间：
1996-06-01
影响因子：
1.7
通讯作者：
Yu, VL
中科院分区：
文献类型：
--
作者：
Singh, N;Squier, C;Yu, VL
不遵守治疗是一个重大问题，特别是当疾病过程是慢性的，治疗方案长期使用时。我们通过对46名年龄在23岁至68岁的人类免疫缺陷病毒感染患者的纵向观察研究，评估了人类免疫缺陷病毒感染患者抗逆转录病毒治疗依从性的患病率和变量。在基线和每6个月对所有患者的人口统计学、医疗状况、身体功能（Karnofsky表现评分）、CD4淋巴细胞计数、抑郁（贝克抑郁量表）、应对（应对疾病量表评分）、心理和情绪压力（情绪状态量表评分）等数据进行前瞻性评估。在6个月和12个月时评估依从性：接受大于或等于80%抗逆转录病毒治疗的患者被认为是依从性的。总体而言，63%的患者接受了抗逆转录病毒治疗。年龄、教育、就业、宗教支持和感知生活质量与依从性无关。单因素分析显示，无静脉用药史与依从性显著相关（p = 0.01）。依从性患者的适应性应对显著改善（p = 0.03），抑郁程度显著降低（p = 0.04）。通过多因素分析，黑人种族与不遵规性有显著相关性，与静脉用药和文化程度无关。先前的机会性感染史（可能会提高疾病的严重程度）（p = 0.02）和较小的心理障碍评分（p = 0.02）与依从性相关。尽管依从性患者服用的处方药数量较多，但仍观察到依从性（p = 0.04）。在12个月时，依从性患者的Karnofsky评分更好（p = 0.02），尽管死亡率没有差异。除了确定依从性的预测因素外，我们的数据表明，在不依从性患者中寻找抑郁和心理压力的症状。
Non-compliance with therapy is a significant problem, particularly when the disease process is chronic and therapeutic regimens are employed for prolonged periods. We assessed the prevalence and variables associated with compliance with antiretroviral therapy in patients with human immunodeficiency virus infection, by means of a longitudinal observational study of 46 patients aged 23 to 68 years, with human immunodeficiency virus infection, followed at the Pittsburgh VA Medical Center. Data on demographics, medical status, physical functioning (Karnofsky performance scores), CD4 lymphocyte count, depression (Beck depression inventory), coping (inventory of coping with illness scale scores), and psychological and emotional stress (profile of mood states scale scores), were prospectively assessed on all patients at baseline and every 6 months. Compliance was assessed at 6 and 12 months: patients taking greater than or equal to 80% of antiretroviral therapy were considered compliant. Overall, 63% of patients were compliant with antiretroviral therapy. Age, education, employment, religious support, and perceived quality of life did not correlate with compliance. By univariate analysis, lack of prior intravenous drug use was significantly associated with compliance (p = 0.01). Compliant patients had significantly better adaptive coping (p = 0.03), and less depression (p = 0.04). By multivariate analysis, black race was significantly associated with non-compliance independent of intravenous drug use and educational status. History of prior opportunistic infection (which presumably heightens the perceived severity of illness) (p = 0.02), and lesser psychological disturbance scores (p = 0.02) were associated with compliance. Compliance was observed despite the greater number of prescription medications taken by compliant patients (p = 0.04). At 12 months, Karnofsky scores were better in compliant patients (p = 0.02), although mortality was not different. Besides identifying predictors of compliance, our data suggest that symptoms of depression and psychological stress be sought in patients with non-adherence.