Longitudinal Analysis of Patterns and Predictors of Changes in Self-Reported Adherence to Antiretroviral Therapy: Swiss HIV Cohort Study
Longitudinal Analysis of Patterns and Predictors of Changes in Self-Reported Adherence to Antiretroviral Therapy: Swiss HIV Cohort Study
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DOI：
10.1097/qai.0b013e3181ca48bf
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发表时间：
2010-06-01
影响因子：
3.6
通讯作者：
Bucher, Heiner C.
中科院分区：
文献类型：
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作者：
Glass, Tracy R.;Battegay, Manuel;Bucher, Heiner C.
背景资料：坚持联合抗逆转录病毒治疗（cART）是一个动态的过程，然而，随着时间的推移，在坚持行为的变化是不充分understood.Methods：数据自我报告错过剂量的cART收集每6个月在瑞士HIV队列研究参与者。我们使用轨迹分析确定了与特定cART依从性模式相关的行为组。重复测量logistic回归确定了连续visits.Results之间依从性变化的预测因素：6709人完成了49,071依从性问卷调查[中位数8（四分位数范围：5-10）]，中位随访时间为4.5年（四分位数范围：2.4-5.1）。个体分为4个依从性组：良好（51.8%）、恶化（17.4%）、改善（17.6%）和依从性差（13.2%）。依从性恶化的独立预测因素是年龄较小，基础教育，失去室友，开始静脉注射药物，增加酒精摄入量，抑郁症，HIV感染时间较长，脂肪代谢障碍发作和更换护理人员。依从性改善的独立预测因素是方案简化，改变类cART，更少的时间cART，并开始comedications.Conclusions：治疗，行为变化，生活事件的影响模式的药物摄入量在HIV患者。临床护理提供者应定期监测与依从性恶化相关的因素，并及早干预，以降低治疗失败和耐药性的风险。
Background: Adherence to combination antiretroviral therapy (cART) is a dynamic process, however, changes in adherence behavior over time are insufficiently understood.Methods: Data on self-reported missed doses of cART was collected every 6 months in Swiss HIV Cohort Study participants. We identified behavioral groups associated with specific cART adherence patterns using trajectory analyses. Repeated measures logistic regression identified predictors of changes in adherence between consecutive visits.Results: Six thousand seven hundred nine individuals completed 49,071 adherence questionnaires [ median 8 (interquartile range: 5-10)] during a median follow-up time of 4.5 years (interquartile range: 2.4-5.1). Individuals were clustered into 4 adherence groups: good (51.8%), worsening (17.4%), improving (17.6%), and poor adherence (13.2%). Independent predictors of worsening adherence were younger age, basic education, loss of a roommate, starting intravenous drug use, increasing alcohol intake, depression, longer time with HIV, onset of lipodystrophy, and changing care provider. Independent predictors of improvements in adherence were regimen simplification, changing class of cART, less time on cART, and starting comedications.Conclusions: Treatment, behavioral changes, and life events influence patterns of drug intake in HIV patients. Clinical care providers should routinely monitor factors related to worsening adherence and intervene early to reduce the risk of treatment failure and drug resistance.