Substance use and mental health correlates of nonadherence to antiretroviral medications in a sample of patients with human immunodeficiency virus infection
Substance use and mental health correlates of nonadherence to antiretroviral medications in a sample of patients with human immunodeficiency virus infection
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DOI：
10.1016/s0002-9343(03)00093-7
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发表时间：
2003-05-01
影响因子：
5.9
通讯作者：
Gifford, AL
中科院分区：
文献类型：
--
作者：
Tucker, JS;Burnam, MA;Gifford, AL
目的：精神健康和药物使用问题在感染人类免疫缺陷病毒（HIV）的患者中很常见，并可能阻碍抗逆转录病毒治疗方案的坚持。本研究调查了抗逆转录病毒药物不依从性与特定类型的精神疾病和药物使用以及不同程度的酒精使用的关系。方法：数据来自全国2267名（代表181557名）参加艾滋病毒成本和服务利用研究的成年人的概率样本调查。这项研究的重点是在过去一周内报告抗逆转录病毒药物依从性的1910名患者。结果：抑郁症患者（优势比[OR] = 1.7； 95%可信区间[Cl]: 1.3至2.3）、广泛性焦虑障碍（OR = 2.4; 95% CI: 1.2至5.0）或惊恐障碍（OR = 2.0; 95% CI: 1.4至3.0）比无精神障碍的患者更容易出现非依从性。不依从性也与前一个月使用可卡因（OR = 2.2; 95% Cl: 1.2至3.8）、大麻（OR = 1.7; 95% Cl: 1.2至2.3）、安非他明（OR = 2.3; 95% Cl: 1.2至4.2）或镇静剂（OR = 1.6; 95% Cl: 1.0至2.4）有关。与不饮酒的患者相比，中度饮酒者（OR = 1.6; 95% CI: 1.3至2.0）、重度饮酒者（OR = 1.7; 95% Cl: 1.3至2.3）或频繁重度饮酒者（OR = 2.7; 95% Cl: 1.7至4.5）更容易出现不依从性。这些关联不能用人口统计学、临床和治疗因素来解释。结论：这些发现表明，需要筛查和治疗艾滋病毒阳性患者的精神健康和物质使用问题，以提高抗逆转录病毒药物的依从性。(C)2003年由摘录医疗公司。
PURPOSE: Mental health and substance use problems are common among patients infected with human immunodeficiency virus (HIV) and may impede adherence to antiretroviral regimens. This study investigated associations of antiretroviral medication nonadherence with specific types of psychiatric disorders and drug use, and varying levels of alcohol use.METHODS: Data were drawn from a survey of,a national probability sample of 2267 (representing 181,557) adults enrolled in the HIV Cost and Services Utilization Study. This study focused on 1910 patients who reported their antiretroviral medication adherence during the past week.RESULTS: Patients with depression (odds ratio [OR] = 1.7; 95% confidence interval [Cl]: 1.3 to 2.3), generalized anxiety disorder (OR = 2.4; 95% CI: 1.2 to 5.0), or panic disorder (OR = 2.0; 95% CL 1.4 to 3.0) were more likely to be nonadherent than those without a psychiatric disorder. Nonadherence was also associated with use of cocaine (OR = 2.2; 95% Cl: 1.2 to 3.8), marijuana (OR = 1.7; 95% Cl: 1.2 to 2.3), amphetamines (OR = 2.3; 95% Cl: 1.2 to 4.2), or sedatives (OR = 1.6; 95% Cl: 1.0 to 2.4) in the previous month. Compared with patients who did not drink, those who were moderate (OR = 1.6; 95% CI: 1.3 to 2.0), heavy (OR =: 1.7; 95% Cl: 1.3 to 2.3), or frequent heavy (OR = 2.7; 95% Cl: 1.7 to 4.5) drinkers were more likely to be nonadherent. These associations could not be explained by demogaphic, clinical, and treatment factors.CONCLUSION: These findings suggest the need for screening and treatment for mental health and substance use problems among HIV-positive patients to improve adherence to antiretroviral medications. (C)2003 by Excerpta Medica Inc.