Adherence to highly active antiretroviral therapies (HAART) in HIV-infected patients: from a predictive to a dynamic approach
Adherence to highly active antiretroviral therapies (HAART) in HIV-infected patients: from a predictive to a dynamic approach
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DOI：
10.1016/s0277-9536(01)00125-3
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发表时间：
2002-05-01
影响因子：
5.4
通讯作者：
Moatti, JP
中科院分区：
文献类型：
--
作者：
Spire, B;Duran, S;Moatti, JP
迄今为止，大多数关于艾滋病毒感染者坚持高效抗逆转录病毒疗法（HAART）的社会行为研究都是基于横断面研究。法国APROCO队列研究使我们有机会联合分析HAART的短期依从性与HIV感染患者在开始治疗前的特征之间的关系，以及与HAART患者主观体验相关的因素。在第一次开HAART处方（MO）后的第四个月随访（M4）时，我们的样本445例患者中有26.71%的患者自我报告了不依从行为。在多变量分析中，MO时的一些患者特征（年龄较小、住房条件差、缺乏社会支持和既往抗逆转录病毒治疗依从性问题）与M4时的非依从性相关。然而，M4的不依从性也与影响MO和M4之间的许多因素的演变有关：抑郁水平，与治疗副作用相关的症状，对个人健康状况的看法，对HAART有效性和毒性的信念，酒精和烟草消费的增加，以及与医院HAART处方者以外的其他医生的接触。我们的前瞻性研究提供了额外的证据，即使是短期的不遵守不能可靠地预测的唯一基础上，一些先验的患者特征，临床医生可以很容易地确定开始HAART。它表明，一个动态的方法来坚持，不断监测HAART经验对患者的日常生活的影响，需要改善管理艾滋病毒/艾滋病护理。(C)2002爱思唯尔科技有限公司版权所有。
To-date, most socio-behavioural research about HIV-infected patients' adherence to highly active antiretroviral therapies (HAART) has been based on cross-sectional studies. The French APROCO cohort gave us the opportunity to conjointly analyse the relationships between short-term adherence to HAART and HIV-infected patients' characteristics before initiation of treatment on the one hand, factors related to patients' subjective experience with HAART on the other hand. At the fourth-month follow-up visit (M4) after first prescription of HAART (MO), 26.71% of our sample of 445 patients self-reported non-adherence behaviour. Some patients' characteristics at MO (younger age, poor housing conditions, lack of social support, and problems of adherence with previous antiretroviral regimens) were related to non-adherence at M4 in multivariate analysis. Non-adherence at M4 was, however, also related to the evolutions that affected a number of factors between MO and M4: levels of depression, symptoms associated with treatment side effects, perception of individual state of health, beliefs towards effectiveness and toxicity of HAART, increases in alcohol and tobacco consumption, as well as contacts with other physicians than hospital HAART prescribers. Our prospective study brings additional evidence that even short-term non-adherence cannot be reliably predicted on the sole basis, of a few a priori patient characteristics that clinicians could easily identify before initiation of HAART. It suggests that a dynamic approach to adherence, continuously monitoring the impact of experience with HAART on patients' daily lives, is needed for improving management of HIV/AIDS care. (C) 2002 Elsevier Science Ltd. All rights reserved.