Predictors of self-reported adherence and plasma HIV concentrations in patients on multidrug antiretroviral regimens.
Predictors of self-reported adherence and plasma HIV concentrations in patients on multidrug antiretroviral regimens.
复制标题
接受多药抗逆转录病毒治疗方案的患者自我报告的依从性和血浆 HIV 浓度的预测因素。
DOI：
10.1097/00126334-200004150-00005
复制
发表时间：
2000
期刊：
影响因子：
--
通讯作者：
Bozzette,SA
中科院分区：
文献类型：
--
作者：
Gifford,AL;Bormann,JE;Shively,MJ;Wright,BC;Richman,DD;Bozzette,SA
背景：坚持服用处方药物是良好的临床HIV护理的核心特征，但人们对与多药抗逆转录病毒坚持相关的因素或这种坚持与血浆HIV抑制之间的关系知之甚少。方法：我们收集了133名接受抗逆转录病毒治疗的HIV感染者的数据。研究对象完成了定制的依从性自我报告工具，并提供了血液样本来测量血浆HIV-1RNA浓度和CD4+淋巴细胞计数。结果：28%(95%可信区间，20%~36%)抗逆转录病毒药物依从性差(平均80%/天)，23%(95%可信区间，15%~30%)一般(80%~99%/天)，50%(95%可信区间，41%~58%)优良(100%/天)。在这三个组中，艾滋病毒-1浓度从历史最高水平分别下降了1.3log10拷贝/毫升、1.6log10拷贝/毫升和2.0log10拷贝/毫升(χ2；p<；02)。两阶段最小二乘回归表明，病毒载量的对数差异与每一类别依从性的改善相关。在多变量模型中，对服药能力或自我效能的信心，以及服药方案的便利性，或与常规和日常活动的“匹配”，也与更大的服药依从性相关(优势比[OR]5.3；95%CI，2.4-11.8)。和9.0；95%可信区间分别为1.8~45.3)。后者也独立地与较低的血浆HIV浓度相关(p<；。结论：不坚持服用联合抗逆转录病毒药物是很常见的，并与血浆HIV水平的升高有关。改善服药的计划和临床努力应努力将药物更好地融入患者的日常生活，并提高患者对自己正确服药能力的信心。
Background:Adherence to prescribed medications is a central feature of good clinical HIV care, but little is known about the factors associated with multidrug antiretroviral adherence, or about how such adherence is related to plasma HIV suppression.Methods:We collected data from 133 HIV-infected adults receiving antiretroviral therapy. Study subjects completed customized adherence self-report instruments and provided blood samples to measure plasma HIV-1 RNA concentrations and CD4+ lymphocyte counts. Regression models were used to determine the independent predictors of antiretroviral adherence and plasma HIV concentration, and the relationships between the two.Results:Adherence was poor (average,< 80% antiretrovirals/day) in 28%(95% confidence interval [CI], 20%-36%), fair (80%-99% per day) in 23%(95% CI, 15%-30%), and excellent (100% per day) in 50%(95% CI, 41%-58%) of study subjects. Mean decreases in HIV-1 concentration from highest-ever levels were 1.3, 1.6, and 2.0 log 10 copies/ml in these three groups, respectively (χ 2; p<. 02). Two-stage least squares regression demonstrated a-1.3 log difference in viral load associated with each category improvement in adherence. In multivariate models, confidence in medication-taking ability, or perceived self-efficacy, and convenience of the medication regimen, or “fit” with routine and daily activities, were also associated with greater medication adherence (odds ratios [OR] 5.3; 95% CI, 2.4-11.8. and 9.0; 95% CI, 1.8-45.3, respectively). The latter was also independently associated with a lower plasma HIV concentration (p<. 02).Conclusions:Nonadherence to combination antiretroviral medications is common and is associated with increased levels of plasma HIV. Programs and clinical efforts to improve medication taking should strive to integrate medications better into patients' daily routines and to improve patients' confidence in their ability to take medications correctly.