Adherence to antiretroviral treatment in HIV-1 infected subjects : prevalence and associated factors
Year: 2012
Type: dissertation
Study design: Observational Study
Abstract: Introduction: Adherence to antiretroviral regimens is recognized as an essential component of treatment success and high levels are recommended. Previous Portuguese studies regarding adherence to highly active antiretroviral therapy (HAART) reported prevalence rates ranging from 46 to 91%. Study Aims: To characterize prevalence and determinants of patient non-adherence to HAART among HIV-1 infected adult subjects followed up at the HIV outpatient clinic from Hospital de Santa Maria (HSM - Lisbon, Portugal). Methods: Retrospective cohort study with a random sample of HIV-1 infected adult subjects that had at least one antiretroviral refill between 01-01-2005 and 31-12-2008. Non-adherence was defined as medication possession ratio (MPR) <95%. HAART regimens, viral load (VL), CD4 cell count and other clinical variables related to HIV/AIDS infection were retrieved. Results: A total of 186 subjects were included in the study. Over the period 2005-2008, the proportion of MPR <95% significantly increased from 12.3% in 2005 to 25.9% in 2008 (P=0.03), being higher among injection drug users (IDUs) and subjects with depression/anxiety and during second calendar semesters, during the study period. The proportion of detectable VL has significantly decreased from 43.5% in the first semester of 2005 to 29.2% in the second semester of 2008 (P=0.01). For the analysis of non-adherence determinants in 2008, a total of 157 subjects were included. Having periods >12 months without medical appointments previous to baseline and ≤3 years of HAART experience were significantly associated to non-adherence. The majority (81.6%) of the non-adherent subjects had more than one medication gap with length <30 days. A significant decrease in the proportion of subjects with CD4 count <350/μl and VL >40copies/ml was observed when increasing the average adherence to HAART. Discussion: Adherence seems to be lower among IDU and subjects with depression / anxiety, and during second calendar semesters. Subjects with less HAART experience and those that had already abandoned medical appointments are more likely to be non-adherent and should have more frequent monitoring of adherence. Future studies should provide national information on adherence to HAART.
Author: Milene Fernandes
Language: English
Subfield: Infectious Diseases
Field: Medicine
Domain: Health Sciences
Open Access status: green
OpenAlex ID: W2260970976