The association of perceived health, clinical status, and initiation of HAART (highly active antiretroviral therapy) in adolescents
The association of perceived health, clinical status, and initiation of HAART (highly active antiretroviral therapy) in adolescents
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DOI：
10.1016/s1054-139x(01)00279-8
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发表时间：
2001-09-01
影响因子：
7.6
通讯作者：
Ma, Y
中科院分区：
文献类型：
--
作者：
Schwarz, DF;Henry-Reid, L;Ma, Y
目的：研究与青少年开始高活性抗逆转录病毒治疗（HAART）相关的因素，以更好地了解目前美国国立卫生研究院（NIH）指南在实践中的使用情况。方法：选取15个REACH临床站点的HIV感染者和未接受haart治疗的青少年。使用广义估计方程的重复测量方法用于确定受试者人口统计学特征、危险行为、感知健康和临床状态与前24个研究月内HAART启动结果测量之间的关联。结果：共有219名受试者符合分析条件；115例（53%）使用了高效抗逆转录病毒疗法。与HAART处方显著的单变量关联包括较低的CD4(+) T细胞计数（OR = 1.7, 95% CI: 1.1-2.6）、较高的病毒载量（OR = 2.7, 95% CI: 1.5-5.0）和HAART处方的日历年（OR高达2.4,95% CI: 1.1-5.2）。多因素结果显示，在控制CD4+ T细胞计数低于500个细胞/毫米(3)后，较高的血浆HIV-1 RNA（小于或等于10,000拷贝/毫升）和时间因素，具有高中文凭/GED但没有继续教育（or = 2.7, 95% CI: 1.3-5.5）和受试者健康状况不佳的感觉（or = 0.987; 95% CI: 0.975 - 0.999）与HAART处方独立相关。在这个队列中，HAART最有可能在1998年上半年开处方（OR = 10.8; 95% CI: 4.0-29.0）。结论:在这项首次针对感染艾滋病毒的青少年进行的HAART处方研究中，认为健康状况不佳和拥有高中文凭/GED与HAART的处方独立相关，这表明接受治疗的个人决定与相信自己的健康状况正在恶化有关，开出治疗的决定可能在某种程度上与处方者对患者掌握治疗方案的能力以及临床状况的评估有关。(C)青少年医学学会，2001年。
Purpose: To examine factors associated with the initiation of highly active antiretroviral therapy (HAART) in adolescents to understand better how current National Institutes of Health (NIH) Guidelines are being used in practice.Methods: HIV infected and HAART-naive adolescents seen at 15 REACH clinical sites were selected. Repeated measures methodology using generalized estimating equations was applied to identify associations between subject demographic characteristics, risk behaviors, perceived health, and clinical status with the outcome measure of HAART initiation during the first 24 study months.Results: A total of 219 subjects were eligible for analysis; HAART was prescribed in 115 (53%). Significant univariate associations with HAART prescription included lower CD4(+) T cell counts (OR = 1.7, 95% CI: 1.1-2.6), higher viral loads (OR = 2.7, 95% CI: 1.5-5.0), and calendar year of HAART prescription (OR as high as 2.4, 95% CI: 1.1-5.2). Multivariate results showed that after controlling for CD4+ T cell counts below 500 cells/mm(3), higher plasma HIV-1 RNA (less than or equal to 10,000 copies per ml), and temporal factors, having a high school diploma/GED but no further education (OR = 2.7, 95% CI: 1.3-5.5) and subject's perception of poor health status (OR = .987; 95% CI:.975-.999) were independently associated with prescription of HAART. HAART was most likely to be prescribed during the first half of 1998 in this cohort (OR = 10.8; 95% CI: 4.0-29.0).Conclusions: In this first ever study of HAART prescription in adolescents infected with HIV, perception of poor health status and having a high school diploma/GED were independently associated with prescription of HAART suggesting that the personal decision to accept therapy is related to the belief that one's health is deteriorating and that the decision to prescribe therapy may be linked in some fashion to the prescriber's assessment of the patient's ability to master the regimen as well as clinical status. (C) Society for Adolescent Medicine, 2001.