Longitudinal antiretroviral adherence among adolescents infected with human immunodeficiency virus
Longitudinal antiretroviral adherence among adolescents infected with human immunodeficiency virus
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DOI：
10.1001/archpedi.159.8.764
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发表时间：
2005-08-01
影响因子：
--
通讯作者：
Muenz, LR
中科院分区：
文献类型：
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作者：
Murphy, DA;Belzer, M;Muenz, LR
目的：纵向跟踪一组感染人类免疫缺陷病毒（HIV）的青少年，调查抗逆转录病毒治疗的长期依从性和与依从性相关的因素。设计、环境和患者：来自美国13个城市的感染艾滋病毒的青少年（N = 231，平均年龄18.4岁，72.7%为女性，74.9%为非洲裔美国人）每隔3个月进行一次评估。主要结果测量：自我报告的依从性测量通过与HIV-1 RNA病毒载量的比较得到验证，并评估可能与抗逆转录病毒治疗依从性相关的行为因素。结果：在初次访问时，大约69%的青少年报告坚持抗逆转录病毒治疗。与早期艾滋病毒感染阶段的青少年相比，晚期艾滋病毒感染阶段的青少年粘附性较低。青少年在周末和前一个月的时间里，较少饮酒和上学与坚持服药有关。对65名受试者进行纵向依从性调查，这些受试者最初坚持至少连续4次就诊。不坚持治疗的中位时间为12个月，未能坚持治疗与年轻和抑郁显著相关。在达到无法检测到病毒载量的青少年中，只有约50%的人在一年内保持无法检测到的病毒载量。结论：这些发现表明，迫切需要更好的干预措施，以帮助青少年艾滋病毒感染者坚持他们的药物治疗方案。患有晚期疾病的青少年可能需要更多的干预。最近发现的对青少年抑郁症有效的新疗法可能有助于提高大多数感染艾滋病毒的青少年的依从性。
Objectives: To longitudinally follow a cohort of adolescents with human immunodeficiency virus (HIV) and to investigate long-term antiretroviral therapy adherence and factors associated with adherence.Design, Setting, and Patients: Adolescents infected with HIV (N = 231; mean age, 18.4 years; 72.7% female; 74.9% African American) from 13 cities throughout the United States were assessed at 3-month intervals.Main Outcome Measures: Self-reported adherence measures were validated by comparison with HIV-1 RNA viral load, and behavioral factors that may be associated with antiretroviral therapy adherence were assessed.Results: At the initial visit, approximately 69% of the adolescents reported being adherent to antiretroviral therapy. Adolescents in the later HIV disease stage were less likely to be adherent compared with those in the earlier disease stage. Less alcohol use and being in school were associated with adherence by adolescents on weekends and over the preceding month. Longitudinal adherence was investigated among 65 subjects initially adherent with available information for at least 4 consecutive visits. The median time to nonadherence was 12 months, and failure to maintain adherence was significantly associated with younger age and depression. Among adolescents who attained an undetectable viral load, only about 50% maintained an undetectable viral load for the year.Conclusions: These findings indicate an urgent need for better interventions to assist adolescents with HIV in adhering to their medication regimens. Adolescents with advanced disease are likely to need more intervention. New treatments recently found effective for adolescent depression may assist in improving adherence for a majority of adolescents with HIV.