Characteristics of HIV antiretroviral regimen and treatment adherence

Abstract

The relationship between characteristics of HIV antiretroviral regimens and treatment adherence was studied in adolescent and adult patients who underwent antiretroviral therapy from January 1998 to September 2000, at the Service for Specialized Assistance in Pelotas. The patients were interviewed on two occasions, and the use of antiretrovirals during the previous 48 hours was investigated by a self-report. Adherence was defined as use of 95% or more of the prescribed medication. Social-demographic variables were collected through direct questionnaires. The antiretroviral regimen and clinical data were copied from the patients' records. Associations between the independent variables and adherence were analyzed by means of logistic regression. The multivariate analysis included characteristics of the antiretroviral regimens, socialdemographic variables, as well as perception of negative effects, negative physiological states, and adverse effects of the treatment. Among the 224 selected patients, 194 participated in our study. Their ages varied from 17 to 67 years; most patients were men, with few years of schooling and a low family income. Only 49% adhered to the treatment. Adherence to treatment regimens was reduced when more daily doses were indicated: three to four doses (odds ratio of adherence to treatment (OR)=0.47, 95% confidence interval (CI) 0.22-1.01) and five to six (OR=0.24, 95% CI 0.09-0.62); two or more doses taken in a fasting state (OR=0.59, 95% CI 0.11-0.68), and for patients who reported adverse effects to the treatment (OR=0.39, 95% CI 0.19-0.77). Most of the regimens with more than two daily doses of medication included at least one dose apart from mealtimes. The results suggest that, if possible, regimens with a reduced number of doses should be chosen, with no compulsory fasting, and with few adverse effects. Strategies to minimize these effects should be discussed with the patients.

The first ten years: achievements and challenges of the Brazilian program of universal access to HIV/AIDS comprehensive management and care, 1996-2006

“…25 . Such discrepancies in terms of what is being measured and how it is being measured may explain the variation observed, with a range of 52 to 83% of patients considered "adherent" to ARV therapy 26,27,28,29,30,31,32,33,34,35,36,37 .…”

“…Self-efficacy and a lower number of daily doses were found to be associated with a better adherence 34 . In a companion paper 35 , the authors suggest adherence could be maximized by regimens with a lower number of doses, with no compulsory fasting, and with fewer adverse effects.…”

Avaliação da adesão aos anti-retrovirais em um município no Sul do Brasil

“…Por meio do auto-relato, os índices, para ser considerados aderentes, variam de 80% a 95% da ingesta das doses diárias em determinado tempo, que pode ser de dois 17 , três 1 15 , sete 13 e trinta dias 10 ou até durante todo o tratamento 3 . Para um índice de 80% de adesão, a taxa de aderentes encontrados é de 69% 15 , ou de 75,8% 13 , ou de 83,2% 3 .…”

Fatores de proteção relacionados à promoção de resiliência em pessoas que vivem com HIV/AIDS

“…Com o avanço do tratamento para AIDS, tornou-se extremamente importante que os pacientes tenham uma boa adesão aos esquemas terapêuticos, a fim de que estes sejam efetivos 7,54,55 . Essa adesão, entretanto, até o momento, não vem sendo sempre satisfatória 7 .…”