Relationship between HAART adherence and adipose tissue alterations
Relationship between HAART adherence and adipose tissue alterations
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DOI：
10.1097/00126334-200212153-00011
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发表时间：
2002-12-15
影响因子：
3.6
通讯作者：
Galli, M
中科院分区：
文献类型：
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作者：
Ammassari, A;Antinori, A;Galli, M
脂肪组织改变(ATA)在接受高效抗逆转录病毒治疗(HAART)的患者中很常见，可产生实质性的心理反应，从而对患者的生活质量和HAART的依从性产生负面影响。然而，这些研究的横截面性质排除了确定关系的方向和因果关系的可能性。作者评估了ATA与HAART依从性之间的纵向关系。这项分析包括了意大利队列朴素抗逆转录病毒药物(IconA)的AdiCoNA和LipoICoNA亚研究的所有参与者。依从性是通过16个项目的自我管理问卷进行评估的，其中还包括一个关于过去4周经历的自我感觉脂肪积累的问题。ATA在注册时由医生诊断，此后每6个月进行一次评估。有207名患者，年龄中位数为35岁；73%为男性；34%通过注射吸毒感染艾滋病毒。在基线时，63%的参与者报告了不依从性，15%的人自我感觉到ATA，25%的人临床诊断为ATA。经COX回归分析，基线依从性好的患者更有可能发生ATA(相对湿度2.58；95%CI，1.09-6.11)，并且发展得更早。基线时自我感觉的ATA与随后的不依从性独立相关(OR，4.67；95%CI，1.01-22.4)，但临床诊断的ATA不相关(OR，0.77；95%CI，0.37-1.61)。患者对HAART的依从性是一个与ATA相互作用的动态过程。更好的依从性与随后发生ATA的风险更高相关，而患者感觉到的形态改变的开始可能会减少对抗逆转录病毒治疗的依从性。
Adipose tissue alterations (ATA), which are common among persons treated with highly active antiretroviral therapy (HAART), can have substantial psychologic repercussions, with a subsequent negative impact on the patient's quality of life and on HAART adherence. However, the cross-sectional nature of the studies precludes establishing the direction and causality of the relationship. The authors evaluated the longitudinal relationship between ATA and adherence to HAART. The analysis included all participants in the AdiCoNA and the LipoICoNA substudies of the Italian Cohort Naive Antiretrovirals (ICoNA). Adherence was assessed using a 16-item self-administered questionnaire, which also included a question on self-perceived fat accumulation experienced during the past 4 weeks. ATA was diagnosed by physicians at enrollment and evaluated every 6 months thereafter. There were 207 patients, with a median age of 35 years; 73% were men; and 34% acquired HIV through injection drug use. At baseline, nonadherence was reported by 63% of participants, and ATA was self-perceived by 15% and clinically diagnosed in 25%. Using Cox regression analysis, patients with good adherence at baseline were more likely to develop ATA (RH 2.58; 95% Cl, 1.09-6.11) and developed it sooner. Self-perceived ATA at baseline was independently related to subsequent nonadherence (OR, 4.67; 95% CI, 1.01-22.4), but clinically diagnosed ATA was not (OR, 0.77; 95% CI, 0.37-1.61). Patients' adherence to HAART is a dynamic process that interacts with ATA. Better adherence is associated with a higher risk of subsequent occurrence of ATA, while patient-perceived onset of morphologic alterations can reduce adherence to antiretroviral therapy.