Adherence to antiretroviral and Pneumocystis prophylaxis in HIV disease
Adherence to antiretroviral and Pneumocystis prophylaxis in HIV disease
复制标题
DOI：
10.1097/00042560-199806010-00003
复制
发表时间：
1998-06-01
期刊：
影响因子：
--
通讯作者：
Moore, RD
中科院分区：
文献类型：
--
作者：
Eldred, LJ;Wu, AW;Moore, RD
背景：慢性病治疗中的药物不依从性损害了治疗的有效性。关于艾滋病的药物治疗依从性或药物治疗依从性的决定因素的程度，在这个新的治疗时代的组合antiretroviral therapy.Methods的问题越来越重要的信息很少：我们研究了244艾滋病毒感染的医疗补助保险患者参加艾滋病毒医院为基础的诊所的程度和预测因素的坚持抗逆转录病毒治疗和卡氏肺孢子虫肺炎（PCP）预防。患者被要求报告正在服用的药物，使用模式以及对艾滋病毒治疗的知识和态度。使用Kappa统计量将病历报告的药物类型、剂量和频率与自我报告进行比较。尿磺胺甲恶唑测定从患者处方磺胺甲恶唑，甲氧苄啶。结果：在患者处方抗逆转录病毒治疗，60%的报告大于或等于80%的坚持在过去的7天，49%的报告大于或等于80%的坚持与PCP预防在过去的7天。报告每日服用磺胺甲恶唑-甲氧苄啶的患者中有79%可检测到尿液中的磺胺甲恶唑。在多变量分析中，大于或等于80%的抗逆转录病毒治疗依从性与每天服药少于或等于两次相关（比值比[OR] = 1.44; 95%置信区间[CI]，1.01，1.96），可能在不在家时服用药物，（OR = 1.41; 95%CI，1.04，2.00）和患者对自己坚持治疗能力的信念（OR = 1.57; 95%CI，1.13，2.17）。对于PCP预防，大于或等于80%的依从性与家人的存在（OR = 2.39; 95%CI，1.01，5.63）和患者对自己坚持治疗能力的信念（OR = 2.87; 95%CI，1.44-1.78）相关。社会人口学特征和信念的药物疗效不相关的adherence.Conclusions：一个相对较低的水平，坚持抗逆转录病毒治疗和PCP预防性方案被发现，虽然我们的研究结果主要是从患者接受抗逆转录病毒单药治疗，这些研究结果可能有重要意义的患者接受高效抗逆转录病毒治疗（HAART）。降低抗逆转录病毒治疗方案的复杂性，并与患者合作修改已确定的依从性障碍，可能会提高药物的有效性并延长生存期。
Background: Medication nonadherence in the treatment of chronic diseases compromises the effectiveness of therapy. Little information is available about the extent of medication adherence or determinants of medication adherence in HIV disease, an issue of increasing importance in this new therapeutic era of combination antiretroviral therapy.Methods: We studied 244 HIV-infected Medicaid-insured patients attending an HIV hospital-based clinic regarding the extent of and predictors of adherence to antiretroviral therapy and Pneumocystis carinii pneumonia (PCP) prophylaxis. Patients were asked to report medications being taken, patterns of use, and knowledge and attitudes about HIV therapies. Medical record report of type, dose, and frequency of medication was compared with self-report using the kappa statistic. Urine sulfamethoxazole assay was obtained from patients prescribed sulfamethoxazole-trimethoprim.Results: Among patients prescribed antiretroviral therapy, 60% reported greater than or equal to 80% adherence in the previous 7 days; 49% reported greater than or equal to 80% adherence with PCP prophylaxis in the previous seven days. Seventy-nine percent of patients who reported taking daily sulfamethoxazole-trimethoprim had detectable urinary sulfamethoxazole. In multivariate analysis, greater than or equal to 80% adherence to antiretroviral therapy was associated with taking medication less than or equal to twice a day (odds ratio [OR] = 1.44; 95% confidence interval [CI], 1.01, 1.96), being likely to take medication when not at home, (OR = 1.41; 95%CI, 1.04, 2.00) and patients' belief in their ability to adhere to therapy (OR = 1.57; 95%CI, 1.13, 2.17). For PCP prophylaxis, greater than or equal to 80% adherence was associated with presence of family (OR = 2.39; 95%CI, 1.01, 5.63) and patients' belief in their ability to adhere to therapy (OR = 2.87; 95%CI, 1.44-1.78). Sociodemographic characteristics and belief in the efficacy of medications were not associated with adherence.Conclusions: A relatively low level of adherence to antiretroviral therapy and PCP prophylactic regimens was found. Although our results are principally from patients receiving antiretroviral monotherapy, these findings may have important implications for patients receiving highly active antiretroviral therapy (HAART). Decreasing the complexity of antiretroviral regimens, and working with patients to modify identified barriers to adherence may improve effectiveness of medications and prolong survival.