Nonadherence to medical appointments is associated with increased plasma HIV RNA and decreased CD4 cell counts in a community-based HIV primary care clinic
Nonadherence to medical appointments is associated with increased plasma HIV RNA and decreased CD4 cell counts in a community-based HIV primary care clinic
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DOI：
10.1080/09540120500101658
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发表时间：
2005-10-01
影响因子：
1.7
通讯作者：
Mayer, KH
中科院分区：
文献类型：
--
作者：
Berg, MB;Safren, SA;Mayer, KH
本研究利用995名在城市社区卫生中心接受初级保健的艾滋病毒感染者一年的人口统计和健康信息，检查了预约不遵守疾病严重程度标志的关系。在最近一次访问中，946例有效病例中有106例（11.2%）CD4小于或等于200,936例有效病例中有454例（48.5%）可检测到血浆HIV RNA（大于50拷贝/ml）。使用逻辑回归，预约不遵守（错过预约的次数）是艾滋病定义CD4计数超过预约次数（p < 0.0001）和患者是否接受HAART治疗（p < 0.002）的重要预测因子（p < 0.03）。预约不遵医嘱也是可检测病毒载量超过预约次数（p < 0.003）、HAART （p < 0.0001）和年龄（p < 0.004）影响的重要预测因子（p < 0.05）。仅观察在最早就诊时可检测到病毒载量的个体，在最近就诊时无法检测到病毒载量的唯一显著独特预测因子是HAART （p < 0.05）。对于那些在早期就诊时病毒载量无法检测到的患者，病毒载量下降到可检测水平的唯一预测因子是预约次数（p < 003）和HAART治疗（p < 0.05）。
This study examined the association of appointment nonadherence to markers of disease severity using one year of demographic and health information on 995 individuals with HIV in primary care at an urban community health centre. At the latest visit, 106 of 946 valid cases (11.2%) had a CD4 less than or equal to 200, and 454 of 936 valid cases (48.5%) had detectable plasma HIV RNA ( greater than 50 copies/ml). Using logistic regression, appointment nonadherence ( number of missed appointments) was a significant predictor (p < .03) of having an AIDS-defining CD4 count over and above the effects of number of kept appointments (p < .0001), and whether or not the patient was taking HAART (p < .002). Appointment nonadherence was also a significant predictor (p < .05) of having a detectable viral load over and above the effects of number of kept appointments (p < .003), HAART (p < .0001) and age (p < .004). Looking only at individuals with a detectable viral load at the earliest visit, the only significant unique predictor of improvement to an undetectable viral load at the latest visit was being on HAART (p < .05). Looking at those only with an undetectable viral load at the earliest visit, the only predictor of declining to a detectable viral load was number of kept appointments (p < 003), and being on HAART (p < .05).