Factors Associated with Adherence to HAART in Patients with HIV/Aids

Transcription

1 ARTIGO ARTICLE Fctors Associted with Adherence to HAART in Ptients with HIV/Aids Ftores Associdos à Adesão o HAART em Pcientes com HIV/Aids Jnin Aprecid S Csotti 1,, Amnd Aprecid S Mendes, Blend N Endlich, Murillo D Queiroz, Rfel S Trtgli, Tâni QR Mott 1, ABSTRACT Introduction: the need for optiml dherence to Highly Active Antiretrovirl Therpy (HAART) is essentil for successful tretment in Acquired immune deficiency syndrome (ids). Ojective: ssess HAART s dherence nd relted sociodemogrphic, clinicl nd lortory vriles. Methods: crosssectionl study. Smple clcultion: 1 mong 0 ptients using HAART. Dt collected etween 1/0/00 nd 0/10/00 t HIV/ids Outptient Clinic of Federl University of Espírito Snto, Vitóri ES. Stndrdized forms nd CEATVIH questionnire trnslted nd dpted to Brzilin lnguge were used to ccess dt nd dherence, respectively. Considering the strict dherence outcomes ( % in the CEATVIH) nd the presence or sence of possily ssocited fctor, univrite nd multivrite nlysis (inry logistic regression) were used nd odds rtio (OR) ws the ssocition mesure ssessed. Results: strict dhesion ws found in % of ptients nd men dhesion ws 1.1%. Mediction use filure ws reported y 6.% of interviewed nd min resons were: forgetfulness (%) nd eing wy from home (0.%). Strict dhesion ws significntly ssocited with higher numer of completed yers of study nd longer durtion of undetectle virl lod. Conclusion: despite n cceptle men dhesion, strict dherence ws poor. Better dherence ws ssocited with higher eductionl level nd longer virologicl suppression. Keywords: ids, dherence, ntiretrovirl therpy, DST RESUMO Introdução: um ótim desão o esquem ntirretrovirl de lt eficáci (HAART) é imprescindível pr o sucesso terpêutico n síndrome d imunodeficiênci dquirid humn (Aids). Ojetivo: verificr desão o HAART e identificr vriáveis sociodemográfics, clínics e lortoriis relcionds est. Métodos: estudo de inquérito simples com cálculo mostrl de 1 pcientes dentre os 0 usndo HAART no Serviço Especilizdo em HIV/Aids d Universidde Federl do Espírito Snto, Vitóri ES. Os ddos form coletdos entre 1/0/00 0/10/00. Formulário pdronizdo e versão trduzid e dptd à relidde rsileir do questionário CEATVIH form utilizdos pr cessr os ddos e desão, respectivmente. Os desfechos form desão estrit ( % no CEATVIH) ou não, e presenç ou usênci de ftor possivelmente ssocido, utilizrmse nálises uni e multivrid (regressão logístic inári) e cálculo d Odds Rtio (OR) como medid de ssocição. Resultdos: desão estrit foi encontrd em % dos pcientes, com médi de desão de 1,1%. Flh no uso d medicção ocorreu em 6,% dos entrevistdos, cujos principis motivos form: esquecimento (%) e estr longe de cs (0,%). Adesão estrit esteve esttisticmente ssocid um mior número de nos completos de estudo e um mior tempo de crg virl indetectável. Conclusão: pesr de um médi de desão ceitável, desão estrit foi instisftóri. Melhor desão esteve ssocid um mior gru de escolridde e mior tempo de supressão virológic. Plvrschve: ids, desão, terpi ntirretrovirl, DST INTRODUCTION Acquired Immune Deficiency Syndrome (ids) pndemy hs gret impct in Brzil nd worldwide, with n estimted. million people infected with Humn Immunodeficiency Virus (HIV) nd. million new cses in 00 in the world. Ltin Americ ccounts for 1.6 million people infected, third of these in Brzil (1). The improved survivl of ptients fter the introduction of Highly Active Antiretrovirl Therpy (HAART) my e evidenced y the incresing decline of ids mortlity worldwide. In Brzil, HAART ws introduced in Unified Helth System (SUS) in 16 y Ministry of Helth, ut the free distriution of zidovudine (AZT), didnosine (ddi) nd zlcitine (DDC) hs occurred since 11 (). Improvement in survivl leds to increse of tretment s resistnce, cused y poor tretment dherence or virologic nd/or immunologic filure (,). 1 Infectious diseses specilist t HIV/Aids Outptient Clinic t University Hospitl Cssino Antonio Mores (HUCAM), Federl University of Espirito Snto (UFES), Vitóri, Espírito Snto, Brzil. Professor of Deprtment of Medicine, Brzilin Fculty (UNIVIX), Vitóri, Espírito Snto, Brzil. Medicl Student, Federl University of Espirito Snto (UFES), Vitóri, ES. Assistnt Professor, Infectious Disese Division, Federl University of Espírito Snto (UFES), Vitóri, ES, Brzil. Finncil support: There is no. In recent yers, severl studies hve emphsized the importnce of dherence to ntiretrovirl tretment s tool for drugs sustinility, where poor complince is mjor cuse of tretment filure (). The dherence filures re founded minly on ignornce out their disese nd the enefits of tretment y ptients; in fct y, strt HAART in cliniclly symptomtic ptients, unfvorle doctorptient reltionship, indequcy of tretment regimen nd ptient dily routine, psychologicl spects of ptient regrding disese nd drug tretment; nd its side effects, mke the strict dherence chllenge (). There re four min wys of ssessing dherence to ntiretrovirl therpy: the use of questionnires, pill count techniques, dosge of drugs in plsm nd electronic monitoring of mediction oxes, ech with dvntges nd limittions (). It is noteworthy, however, tht there is still no gold stndrd for dherence ssessment, eing the most used nd most costeffective the use of questionnires (). Given the mny wys of mesuring ptient dherence to HAART nd nonstndrdiztion of the questionnires used in the studies it is complicted to compre them, so tht, identifiction of min predictors of noncomplince s well s the development of intervention strtegies to improve dherence, lso ecome difficult (). Thus, it is essentil to know the pttern of HAART s dherence in different clinicl settings, nd check sociodemogrphic, clinicl nd lortory findings tht my e ssocited or not with good dherence to tretment. Thus, this study ims to check the sttus of dherence to DOI: 10./60111 DST J rs Doençs Sex Trnsm 011;(): ISSN: ISSN online: 6

2 6 ntiretrovirl tretment nd fctors ssocited with this in specilized cre service for HIV/ids in Vitóri, Espírito Snto, Brzil. METHODS Loction nd study popultion The HIV/Aids Outptient Clinic is locted t University Hospitl Cssino Antonio Mores (HUCAM) in Federl University of Espírito Snto (UFES), Vitóri city, Espírito Snto (ES) stte, Brzil. During the study period the service ws ccount for out 0% of,00 ptients receiving HAART in ES. The study popultion ws 0 ptients living with HIV/ids receiving HAART. This Outptient Clinic hd tem mde up of eleven HIV specilists, two nurses, socil worker, three nurse technicins nd phrmcist. Ech ptient is ssisted y the sme infectious disese specilist t ech visit. Study design The study is crosssectionl survey using simple enquire. The smple size clcultion ws performed using EpiInfo.. considering power of 0% for the test nd n estimte of effect for confidence intervl of %. It ws considered tht the numer of ptients on HAART t HUCAM in April 00 ws 0 ptients, nd the literture dt showing tht the frequency of noncomplince of round 0% (,6,10,11). The smple size ws 1 ptients. Dt ws collected during usiness dys etween 1/0/00 nd 0/10/00. Interviews were performed etween 1/0/00 nd 0/10/00, dt ws collected during usiness dys, with men of three ptients selected every dy y simple rndom etween eligile ptients of the dy. HAART hs een considered the use of three or more ntiretrovirl drugs from t lest two different clsses. All rndomized ptients who greed to prticipte signed n informed consent form. Dt collection ws conducted through questionnire entitled Cuestionrio pr l Evlución de l Adhesion in Antiretrovirl l Trtmiento con persons y infected y HIV ids (CEATVIH) (,1) nd form prepred y the investigtors including sociodemogrphic, clinicl nd lortory chrcteristics of ptients. CEATVIH questionnire is n instrument to mesure the degree of dherence to tretment for people living with HIV/ids using ntiretrovirl drugs. It includes 0 items with the following dimensions: ) tretment dherence, which includes the following vriles: dherence during lst week, generl dherence since principle of tretment, dherence to the time of tking the medictions, ssessment of the ptient s level of commitment, rememering the nmes of drugs included in your tretment. ) fctors tht modulte tretment dherence, which included: history of noncomplince (frequency in sense of feeling etter efore the omission of the mediction, frequency with senstion of feeling worse fter the ingestion of drugs nd frequency of sdness or depression precede noncomplince); doctorptient reltionship; ptient s eliefs out his effort nd time required for dherence nd difficulties in mintining dherence nd expecttions for tretment outcomes; intensity of side effects; degree of drug informtion; degree of stisfction with tretment; improved perception of helth from the strt of tretment; use of strtegies to rememer the schedules of drugs. Totl score of CEATVIH questionnire llows us to identify n overll rte of dherence to ntiretrovirl therpy, which fcilittes CASOTTI et l. the clssifiction of sujects ccording to degree of complince ( strict dherence, insufficient memership (regulr) nd low or indequte ). Strict dherence is defined y n dherence rte % compred to the totl questionnire score (1). After providing written informed consent form, prticipnts nswered to CEATVIH questionnire individully nd then interview ws performed with trined reserchers to fill the form dt. CEATVIH questionnire ws used in Portuguese, Brzilin version; it ws trnslted, dpted nd vlidted for the Brzilin relity from the questionnire proposed y Remor et l. 00 (). This dt collection instrument ws used under the uthor s express permission. Eligiility criteri Inclusion criteri were ge greter thn or equl to 1 yers, positive serology for HIV, use of HAART for t lest 6 months prior to study, e enrolled t HIV/Aids Outptient Clinic HUCAM. Exclusion criteri were: illiterte, those who did not gree to prticipte nd did not sign the consent form, pregnnt women. Chrcteriztion of vriles used in the study. Sociodemogrphic vriles were: ge, mritl sttus, occuption, gender, rce/color, eduction level, employment sttus, per cpit income, fmily sttus. Clinicl vriles were: time of dignosis of HIV infection in yers, durtion of HAART in yers, ids dignosis criterion (Crcs Criterion/Rio de Jneiro or dpted Centers of Disese Control criteri), the wy of HIV cquisition, numer of tlets per dy of HAART, numer of doses per dy of HAART, presence of concomitnt diseses, use of concomitnt medictions, numer of pills per dy of concomitnt medictions, reson of filure in drugs dministrtion, smoking, lcohol. Lortory vriles were: lst count of CD + Tlymphocytes (CD count), HIV virl lod, lower CD count, prior to HAART CD count nd HIV virl lod nd time of undetectle HIV virl lod in weeks. Sttisticl nlysis The descriptive nlysis of continuous quntittive vriles ws represented y its centrl loction nd mesures of vriility, men nd stndrd devition if Gussin model, otherwise medin nd interqurtile rnge. Ctegoricl vriles were represented y their solute nd reltive frequencies. The outcomes were presence of strict dherence ( % y the score of trnsformed questionnire CEATVIH) or its sence, nd presence or sence of ssocited fctor (vrile). The chisqure or Fisher s exct test ws used to compre ctegoricl vriles. For continuous vriles, TStudent test ws used for comprison of norml distriutions etween the two groups (strict dherence or not). For nonnorml distriutions it ws used the MnnWhitney test. Multivrite nlysis ws performed y inry logistic regression model using the Enter method. Vriles tht hve djusted well to the model were those with requirements for logistic regression: e independent, with p < 0.1 in univrite nlysis, cells hve vlue greter thn or equl to one in crossts nd not hve more thn 0% of cells with vlues elow five. Vriles independency ws tested to check whether there ws n ssocition or correltion etween them. It ws used Person s correltion test or chisqure test, s pproprite. When vriles DST J rs Doençs Sex Trnsm 011;():

3 Fctors Associted with Adherence to HAART in Ptients with HIV/Aids were correlted or ssocited, it ws chosen to enter the multivrite model those most significnt in the univrite nlysis or the one most relevnt in clinicl prctice. Adjustment HosmerLemeshow test model ws used in this study. The ssocition mesure clculted from logistic model ws odds rtio (OR). All dt were nlyzed using SPSS Inc, version 1.0. Ethicl considertions Study ws pproved y locl Ethics Committee under registrtion numer 1/0 in ugust 6 th 00.CEAT/HIV questionnire ws used with prior permission from uthor (). RESULTS Descriptive nlysis Eligiility criteri were pplied mong ptients dmitted in HIV/Aids Outptient ClinicHUCAMUFES during the study period (0/1/00 to 0/10/00). All these ptients greed to prticipte nd signed the informed consent form. Of eightyone ptients studied 0 (61.%) were mle; men ge ws.6 yers with stndrd devition (SD) of. yers. Most of them (.1%) lived in Vitóri Metropolitn Region (ES). Aout rce/color, rown represented 0.6% (1), whites.% () nd lcks.% (1). Aout mritl sttus,.% (0) were single,.1% (6) were mrried nd 1. (1%) were seprted or widowed, nd only 1.% of ptients lived lone. Nine (11.1%) ptients hd kept their dignosis of HIV infection in confidence (Tle 1). Regrding eduction, the verge of yers of study ws. (SD ±.). The medin of per cpit mensl income ws R$ 0 reis with interqurtile rnge (IQR) of R$.00 to R$ 0, nd men of R$ 1,6.00 (SD ± R$,1.). Unemployed mounted 1.% (1); others were employed, pensioners or received some sickness support (Tle 1). All ptients hd dignosis of Acquired Immune Deficiency Syndrome (ids) sed on Crcs/Rio de Jneiro (%) or CDC dpted (%) Criterion (Tle 1), the most frequent criterion ws CD < 0 cel/mm (6.%) (Dt not shown in tle). Time of HIV dignosis hd men of. yers (SD ±.0) nd medin of yers (IQR 0 to 0.). The time of HAART ws 6.61 yers (SD ±.1), with medin of. yers (IQR 0. to 0.) (Tle 1). Thirtytwo (.%) ptients hd some comoridities, with heptitis C in 1.6% of cses, hypertension in 1.%, dyslipidemi in.6%, dietes in.% nd heptitis B in.% (dt not shown in tle). HAART used in y.6% of ptients contined nucleoside or nucleotide nlogues comined with protese inhiitor with or without ritonvir ooster, 6.% used comined regimen with non nucleoside nlogue nd.% n ssocition of protese inhiitor nd non nucleoside nlogue. In ddition, twentyeight (.6%) were using concomitnt medictions to HAART (Tle 1). Sixtytwo (6.%) ptients declred filure to tke the ntiretrovirl medictions nd cited s mjor cuses forgetfulness (%), the fct of eing wy from home (0.%) or occupied (%), dverse effects (1.%), chnge in routine (6.%), nd depression, lck of interest nd drug holidys with % ech (Tle 1); were smokers (.%) nd 11 lcoholics (1.6%) respondents (Dt not shown in tle). Regrding lortory dt, the lst CD count hd men of 1 cells/mm (SD ± 0) with medin of cells/mm (IQR Tle 1 Demogrphic, socioeconomic, clinicl nd lortoril chrcteristics of ptients ttended t HIV/ids outptient clinic of Federl University of Espírito Snto, Vitori, ES, 00 (n = 1). Chrcteristics of people Descriptive nlysis interviewed Age (yers).6 (±. SD) Gender Mle 61.% Femle.% Rce/color White.% Blck.% Brown 0.6% Mritl sttus Single.% Mrried.1% Seprted/divorced/widowed 1.% Lives in Vitori metropolitn re.1% 1.1% Yers of study (yers). (±. SD) Per cpit mensl income 1,6.00 (±,1.00 SD) (reis) 0.00 (IQR.00 0,000.00) Work sitution Employee 6.% Unemployed 1.% Fmily sttus Lives lone 1.% Lives with someone 0.% Does nyone know the HIV dignosis?.% 11.1% Aids dignostic criterion Crcs/Rio de Jneiro % CDC dpted % Time of HIV dignosis (yers). (±.0) (IQR 00.) Time of HAART use (yers) 6.61 (±.1 SD). (IQR 0.0.) Comoridities Chronic heptitis C 1.6% Hypertension 1.% Dyslipidemi.6% Dietes mellitus.% Chronic heptitis B.% s or nothing.1% Filure in tking HAART HAART With protese inhiitors (PI) With nonnucleoside nlogues (NNRTI) with PI nd NNRTI 6.%.%.6% 6.%.% Continues DST J rs Doençs Sex Trnsm 011;():

4 Tle 1 (Continution) Demogrphic, socioeconomic, clinicl nd lortoril chrcteristics of ptients ttended t HIV/ids outptient clinic of Federl University of Espírito Snto, Vitori, ES, 00 (n = 1). Chrcteristics of people interviewed Resons for filed tke HAART Forgetfulness Being wy from home Being usy Adverse effects Chnge in the dily routine Depression Lck of interest Drug Holidy Use of concomitnt medictions Lst TCD lymphocytes count (cel/mm ) Ptients with elow detection limit VL/HIV Lst VL/HIV Time of undetectle VL/HIV (months) Rw score otined from CEAT/ HIV Questionnire Score in percentge of CEAT/ HIV Questionnire Strict Adhesion ( % y score in percentge of CEAT/HIV) % 0.% % 1.% 6.% % % % %.6% 6.% Descriptive nlysis 1 (± 0 SD) (IQR ).% 1.0 Log (± 1. SD) 1.0 Log (IQR 1.) 6. (± 0 SD) 6 (IQR 1). (±. SD) 6. (IQR ) 1.1 (± 1.1 SD). (IQR 6) % % te. HIV: Humn Immunodeficiency Virus; ids: Acquired Immune Deficiency Syndrome; HAART, Highly Effective Antiretrovirl Therpy; CD: T CDpositive lymphocytes; VL/HIV: HIV virl lod. Continuous vriles re presented s men ± stndrd devition (SD) nd medin with their interqurtile rnge (IQR). The detection limit of the tests used to quntify VL/HIV hs vried over the yers, hving een in most of the time elow 00 copies/ml nd in the lst yers, < 0 copies/ml. ) ( Tle 1). Of the 1 respondents, (.%) hd HIV virl lod elow the detection limit (< 0 copies/ml). (Dt not shown). And the men lst HIV virl lod logrithm (log) ws 1.0 (SD ± 1.) nd medin 1,0 log (IQR 1 to.). In reltion to the time of undetectle virl lod, the men ws 6. months (SD ± 0) nd the medin 6 months (IQR 1) (Tle 1). Strict dherence ( % y the score of the trnsformed questionnire CEAT/HIV) ws detected in ptients (%) (Dt not shown). Averge of dherence ws 1.1% (SD ± 1) nd medin.% (IQR 6) (Tle 1). Univrite nd multivrite nlysis CASOTTI et l. Univrite nlysis of the dt is shown in Tles nd. It is noteworthy tht vriles with pvlue < 0.1 nd cndidtes for logistic regression model were: rce/color, filure to tke mediction, ge, yers of study, per cpit income nd time of undetectle virl lod. Since forgetfulness nd filure to tke the drugs were ssocited with ech other, we chose to keep this lst vrile ecuse of greter relevnce. After multivrite nlysis y inry logistic regression remined significntly ssocited with strict dherence: yers of study, with odds rtio (OR) for ech dditionl yer of study of 1.01 with confidence intervl of % (CI %) from 1.0 to 1.) nd time of undetectle virl lod (OR 1.0 for ech month more nd CI % 1.00 to 1.06) (Tle ). DISCUSSION The evlution of dherence to longterm cre remins mjor chllenge worldwide. Moreover, there is no gold stndrd methodology for verifiction of dherence to HAART in ptients living with HIV/ids, nd the methodology used in most studies hs een the use of questionnires with selfreport (1). Some studies hve lso used questionnires to otin dt through interviews conducted y trined reserchers (). It is found tht men dherence rtes in different studies differ. This my e due to different study designs, different methods of mesurement nd definitions of dherence used nd lso y different contexts where ptients re. Some use questionnires (self report) prepred y the uthors (1,1,1,0,,), or using stndrdized questionnires vlidted y other (1,,,,), nd nother hve otined the dt through questionnires in interviews (). It is worth noting tht some mesure the rte of complince y percentge of drugs tken in the lst two (1), three (), four (0) or seven (1,,) dys y ptients. CEATVIH questionnire used in this study hs een powerful tool, useful nd efficient wy to detect dherence to HAART in different countries (), nd lso vlidted for use in Brzil (). This study found tht only % of ptients chieved strict dherence ( % dherence y CEATVIH questionnire), which cn e regrded sufficient percentge to therpeutic success. Aout the verge of complince otined y scoring scle of the sme instrument, it cn e considered cceptle (1.1%). And regrdless to men score otined y CEAVIH of. ±. Stndrd Devition (SD), it ppered similr to tht oserved y other uthors using the sme instrument:. ±.66 SD () nd ± 6 SD (), representing n insufficient overll dhesion. The percentge of dherence otined y other uthors ws % y Gifford et l. (1), % y Lignno et l. (), % y Bltt et l. (),.6% y Aelln et l. (1), 0% y Hurich et l. (1),. to.% y Eron et l. (), % y Kleerg et l. (0) nd 1 to % y Murri et l. (). uthors hve shown lower rtes of dherence: Klichmn et l. (1) 6%, Vicin et l. ().%, Motti et l. () 6%, Duong et l. (1) nd Smet et l. () 6%. We emphsize tht it is not possile to compre the ovementioned percentge ecuse it ws cquired using different questionnires, s well s designs nd different definitions of dequte complince. Adverse events to ntiretrovirl therpy is one of the most frequent cuses of poor dherence in some studies (6,). wise DST J rs Doençs Sex Trnsm 011;():

5 Fctors Associted with Adherence to HAART in Ptients with HIV/Aids Tle Results of univrite nlysis (ctegoricl vriles) in ptients ttended t HIV/ids outptient clinic of Federl University of Espírito Snto, Vitóri, ES, 00 (n = 1). Ctegoricl Vriles Gender Mle Femle Rce White Blck Brown Mritl sttus Single Mrried City of residence Vitóri Serr Cricic Vin Vil Velh Gurpri Work sitution Unemployed Employee Does nyone know the HIV/ ids dignosis Fmily sttus Lives lone Lives with someone Concomitnt diseses Chronic heptitis C Hypertension Dyslipidemi HAART With protese inhiitors (PI) With nonnucleoside nlogues (NNRTI) With PI e NNRTI Concomitnt medictions Filure in tking HAART Strict Adhesion (n = ) (n = ) Univrite nlysis pvlue Continues Ctegoricl Vriles Filure due to forgetfulness Filure due to eing usy Filure due to eing wy from home Filure due to dverse effects Smoking Alcoholism Strict Adhesion (n = ) 0 6 (n = ) Tle (Continution) Results of univrite nlysis (ctegoricl vriles) in ptients ttended t HIV/ids outptient clinic of Federl University of Espírito Snto, Vitóri, ES, 00 (n = 1) Univrite nlysis pvlue te. HIV: Humn Immunodeficiency Virus; ids: Acquired Immune Deficiency Syndrome; HAART: Highly Effective Antiretrovirl Therpy. the Chisqure test or Fisher s, s pproprite. pvlue < 0.1, vriles tht entered the inry logistic regression model. other resons for not tking drugs, like forgetting, eing wy from home, chnge in routine, side effects, depression, or concomitnt diseses nd even lck of interest or drug holidy re lso frequent cuses for missed drug doses (,,). In this study, forgetfulness, eing wy from home, eing usy, dverse events nd chnges in dily routine ws the min cuses for the filure in tking ntiretrovirl therpy. These findings re similr to those descried in the literture (,.). Adherence to ntiretrovirl therpy in this study ws independently ssocited in multivrite nlysis with time of undetectle virl lod nd yers of study. It is possile tht longer time of study would fcilitte etter understnding out the disese nd its control leding to correct use of tretment, s it hs een shown y other uthors (,1,6,,,6,,). Wht proly occur in tht scenrio is the etter understnd of disese nd tretment for those ptients with higher eduction. Similrly, Aelln et l. (1) found tht ptients who were instructed y trined nurses out their tretment hd etter dhesion nd Guimrães et l. (6) found tht greter degree of difficulty dhering to tretment occurred in ptients with low understnding of medicl dvice. wise, Zgo et l. (10) verified t tht ndon to HAART were independent ssocited with illicit drug use, previous non dherence of mediction, lst CD < 00 cells/mm nd lst virl lod higher thn 1000 copies/ml. These results corroortes with ours just in lower virl lods (< 1,000 copies/ml for Zgo et l. nd undetectle for our study) predicting good dherence. Due to lrge socioeconomic disprity tht divides the popultion studied, we cn infer this difference could e relted to less DST J rs Doençs Sex Trnsm 011;():

6 0 eduction or difficulties in ccessing helth services, fctors tht directly interfere with dherence to ntiretrovirl tretment. Kleeerg et l. (0) found low complince ssocited with ptients with low income nd Reis et l. () found higher dherence in the highest socil clsses. Low level of eduction cn e so relted to lck understnding y the ptient out severity of his helth condition so tht symptomtic ptients feel comfortle enough to not worry out correct use of mediction. In ddition, mny ptients due to worklod dded to their dily tsks, tend to llocte their helth in secondry role, which might lso justify their filures. Limittions of this study re those inherent to crosssectionl design, prticulrly regrding the vulnerility to selection is Tle Results of univrite nlysis (continuous vriles) in ptients ttended t HIV/ids outptient clinic of Federl University of Espírito Snto, Vitóri, ES, 00 (n = 1). Continuous Vriles Univrite Anlysis pvlue Age (yers) 0.0 c Yers of study 0.00 d Per cpit mensl income (reis) 0.0 c Numer of tlets of HAART per dy 0.1 Numer of doses of HAART per dy 0. Lst CD (cel/mm ) 0. Lst VL/HIV (copies/ml) 0.1 VL/HIV efore HAART (copies/ml) 0. Time of undetectle VL/HIV (months) 0.01 d te. HAART: Highly Effective Antiretrovirl Therpy; CD: T CD positive lymphocytes; VL/HIV: HIV virl lod. The Student t test or MnnWhitney test, s pproprite. The detection limit of the tests used to quntify VL/HIV hs vried over the yers, hving een in most of the time elow 00 copies/ml nd in the lst yers, < 0 copies/ml. c pvlue < 0.1, vriles tht entered the inry logistic regression model. d pvlue < 0.0, significnt nd entered the inry logistic regression model. CASOTTI et l. nd misclssifiction. The possiility of response is, owing to the tendency to provide socilly cceptle nswers, cnnot e excluded. However, descriptive studies such s this cn pve the wy for nlyticl comprisons tht will llow etter understnding of dherence in different popultions nd pln strtegies to minimized ssocited fctors to non dherence. Thus, interventions sed on improvement eduction nd instruction of ptients should e performed leding to etter understnding of infection y ptients through eductionl progrms offered y multidisciplinry tem responsile for their cre. Must e rememered tht time of undetectle virl lod is ssocited with good dherence so tht this lortory technique cn e used when there re douts out the ptients dherence to ntiretrovirl therpy. Further studies re needed to confirm fctors relted to dherence to HAART regimen in other clinicl settings, nd to verify the effectiveness of possile intervention ctions in these ptients with poor dherence. CONCLUSION Despite n cceptle men dhesion, strict dherence ws poor. Better dherence ws ssocited with higher eductionl level nd longer virologicl suppression. Acknowledgments We would like to thnk the ssistnt physicins nd ll stuff of the HUCAM Infectious Diseses Clinic, for their support. Conflict of interest ne. REFERENCES 1. AIDS epidemic updte, 00. Joint United Ntions Progrmme on HIV/ AIDS nd World Helth Orgniztion (WHO). Aville from: (Acessed octoer 1 th 011).. Reis AC, Sntos EM, Cruz MM. A mortlidde por AIDS no Brsil: um estudo explortório de su evolução temporl. Epidemiol. Serv. Súde. 00; ():10. Tle Results of multivrite nlysis in ptients ttended t HIV/ids outptient clinic of Federl University of Espírito Snto, Vitóri, ES, 00 (n = 1). Vriles Univrite nlysis Multivrite nlysis pvlue OR CI % pvlue AdjustedOR CI % Rce White 0.0 Blck Brown Age Per cpit mensl income Filure in tking HAART DST J rs Doençs Sex Trnsm 011;(): Time of undetectle VL/HIV c (months) Yers of study te. Multivrite nlysis ws performed y inry logistic regression model using the Enter method. OR: Odds Rtio; CI %: Confidence Intervl %; HAART: Highly Effective Antiretrovirl Therpy; VL/HIV: HIV virl lod. pvlue < 0.1. pvlue < 0.0. c The detection limit of the tests used to quntify VL/HIV hs vried over the yers, hving een in most of the time elow 00 copies/ml nd in lst yers, < 0 copies/ml.

7 Fctors Associted with Adherence to HAART in Ptients with HIV/Aids. The ntiretrovirl therpy cohort collortion. Prognosis of HIV1 infected ptients up to yers fter initition of HAART: collortive nlysis of prospective studies. AIDS 00;:11.. Hmmer SM. Antiretrovirl tretment of dult HIV infection: 00 recommendtions of the Interntionl AIDS SocietyUSA pnel. JAMA 00;00():0.. Meht S, Moore R, Grhm NMH. Potentil fctors ffecting dherence with HIV therpy. AIDS; 1;11: Willims A, Friedlnd G. Adherence, complince, nd HAART. Aids Clin Cre 1;:1.. Chesney MA. Fctors Affecting Adherence to Antiretrovirl Therpy. Clinicl Infectious Disese. 000;0(Suppl. ):S1.. Remor E, MilnerMoskovics J, Preussler G. Adptção rsileir do Cuestionrio pr l evlución de l dhesión l trtmiento ntiretrovirl. Rev Súde Púlic. 00;1():6.. Ostererg L, Blschke T. Adherence to mediction. N Engl J Med. 00;:. 10. Zgo AM, Morelto P, Endringer EA, Dn GF, Rieiro EM, Mirnd AE. Andonment of ntiretrovirl therpy mong HIVpositive ptients ttended t the reference center for HIV/AIDS in Vitóri, Brzil. JIAPAC. 01;11(1):. 11. Monforte AA, Test L, Adorni F, Chies E, Bini T, Mosctelli GC et l. Clinicl outcome nd predictive fctors of filure of highly ctive ntiretrovirl therpy in ntiretrovirl experienced ptients in dvnced stges of HIV1 infection. AIDS. 1;1:1. 1. Remor E. Mnul pr l evlución de L dhesión l trtmiento ntirretrovirl em persons com infección por VIH y SIDA. Gui pr El usuário Del Cuestionrio pr L evlución de L dhesión l trtmiento ntirretrovirl em persons com infección por VIH y SIDA (CEATVIH). Mdrid: [unkown pulisher]; copyright ISBN pendiente. 1. Aelln J, Grrote M, Pulido F. Evlution of dherence to triple ntiretrovirl therpy in HIVpositive ptients. Eur J Intern Med. 1;10:0. 1. Arnsten J, Dems P, Gourevitch M. Adherence nd virl lod in HIV. Infected drug users: comprison of selfreport nd mediction event monitors (MEMS). Acts de l th Conference on Retroviruses Opportunistic Infections. 000; comunicción 6, p.. 1. Duong M, Piroth L, Peytvin G, Forte F, Kohli E, Grppin M et l. Vlue of ptient selfreport nd plsm humn immunodeficiency virus protese inhiitor level s mrkers of dherence to ntiretrovirl therpy: reltionship to virologic response. Clin Infect Dis. 001;:6.. Eron JJ, Yetzer ES, Rune PJ, Becker S, Swyer GA, Fisher RL et l. Efficcy, sfety, nd dherence with twicedily comintion lmivudine/ zidovudine tlet formultion, plus protese inhiitor, in HIV infection. AIDS. 000;1: Hurich RH, Little SJ, Currier JS, Forthl DN, Kemper CA, Bell GN et l. The vlue of ptientreported dherence to ntiretrovirl therpy in predicting virologic nd immunologic response Cliforni Collortive Tretment Group. AIDS. 1;1: Gifford AL, Bormnn JE, Shively MJ, Wright BC, Richmn DD, Bozzette SA. Predictors of selfreported dherence nd plsm HIV concentrtions in ptients on multidrug ntiretrovirl regimens. J Acquir Immune Defic Syndr. 000;:6. 1. Klichmn SC, Rmchndrn B, Ctz S. Adherence to comintion ntiretrovirl therpies in HIV ptients of low helth litercy. J Gen Intern Med. 1;1:6. 0. Kleeerger CA, Phir JP, Strthdee SA, Detels R, Kingsley L, Jcoson LP. Determinnts of heterogeneous dherence to HIVntiretrovirl therpies in the Multicenter AIDS Cohort Study. J Acquir Immune Defic Syndr. 001;6:.. Motti JP, Crrieri MP, Spire B, Gstut JA, Cssuto JP, Moreu J. Adherence to HAART in French HIVinfected injecting drug users: the contriution of uprenorphine drug mintennce tretment. The Mnif 000 study group. AIDS. 000;1:11.. Murri R, Ammssri A, Gllicno K, De Luc A, Cingolni A, Jcoson D et l. Ptientreported nondherence to HAART is relted to protese inhiitor levels. J Acquir Immune Defic Syndr. 000;:1.. Smet JH, Limn H, Steger KA, Dhwn RK, Chen J, Shevitz AH et l. Complince with zidovudine therpy in ptients infected with humn immunodeficiency virus, type 1: crosssectionl study in municipl hospitl clinic. Am J Med. 1;:0. Doi:10.10/000 ()06X.. Wu AW, YuIsenerg K, McGrth M, Jcoson D, Gilchrist K. Reliility, vlidity nd fesiility of touch screen dministrtion of qulity of life nd dherence instruments in n HIV outptient clinic. Acts del XIII Interntionl AIDS. (TuPpD1). Durn, Vicin P, Ruio R, Rier E, Knoel H, Irirren JÁ, Arris JR et l. Enferm infecc microiol clin. 00;6():1. 6. Ceccto MGB, Acurcio FA, Vllno A, Cesr CC, Guimrães MDC. Evlucion de fctores oscidos L comprension Del trtmiento em pcientes que inicin L terpi ntirretrovirl. Enfermeddes infeccioss y microiologi clínic. 00;(1):1. Doi:10.10/j.eimc Gordillo V, Del Amo J, Sorino V, GonzlezLhoz J. Sociodemogrficd psychologicl vriles influencing dherence to ntiretrovirl therpy. AIDS 1;1(1):1.. Brsil. Ministério d Súde. Secretri de Vigilânci em Súde. Progrm Ncionl de DST/Aids. Mnul de desão o trtmento pr pessos vivendo com HIV/Aids. Brsili: Ministério d Súde, p. (Série A. rms e Mnuis técnicos) (Séries Mnuis; n. ).. Reis AC, Lencstre L, Guerr MP, Remor E. Adptção portugues do questionário pr vlição d desão o trtmento ntiretrovirl (CE ATVIH). Psicologi, súde e doençs. 00;10(): Remor E. Vlorcion de L dhesion l trtmiento ntirretrovirl em pcientes VIH +. Psicothem. 00;1(): Remor E, Penedo FJ, Shen BJ, Schniedermn N. Perceived stress is ssocited with CD cell decline in men nd women living with HIV/Aids in Spin. AIDS Cre. 00;1():1. Doi: / TfurVlderrm E, Ortiz C, Alfro CO, GrciJimenez E, Fus MJ. Adptcion Del Cuestionrio de evlution de L dhesion l trtmiento ntirretrovirl CEATVIH pr su uso no Peru Ars Phrm. 00;():1.. Crvlho CV, MerchnHmnn E, Mtsushit R. Determinntes d desão o trtmento ntiretrovirl em Brsíli, DF: um estudo cso controle. Revist d Sociedde Brsilleir de Medicin Tropicl. 00;0():6.. Bltt CR, Citdin CB, Souz FG, Mello RS, Glto D. Avlição d desão os ntiretroviris em um município no Sul do Brsil. Revist d Sociedde Brsileir de Medicin Tropicl. 00;():1.. Melchior R, Nemes MIB, Alencr TMD, Burchll CM. Chllenges of tretment dherence y people living with HIV/Aids in Brzil. Revist súde pulic. 00;1:. 6. Guimrães MDC, Roch GM, Cmpos LN, Freits FMT, Gulerto FAZ, Teixeir RAR et l. Difficulties reported y HIVinfected ptients using ntiretrovirl therpy in Brzil. Clinics. 00;6():.. Lignni Junior L, Greco D, Crneiro M. Avlição d derênci os nti retroviris em pcientes com infecção pelo HIV/Aids. Rev. Súde Púlic. 001;(6):01.. Hles G, Mitchell J, Smith DE, Kippex S. Vlidity of ptient questioning versus pill count s n ssessment of complince ( strct ). In: Progrm nd strcts of the 1 th World AIDS Conference. Genev: Mrthon Multimedi; 1. (Astrct 1).. Tuldr A, Ferrer MJ, Rodriguez C, Byes R, Burger D, Clotet B. Aproposed model to predict complince with ntiretrovirl therpy ( strct I1 ). In: Progrm nd strcts of the th Interscience Conference on Antimicroil Agents nd Chemotherpy (Sn Diego). Wshington, DC: Americn Society for Microiology; 1:. 0. Puigventos F, Rier M, Delies C, Peñrnd M, Fuente L, Boront A. Estudios de dherenci los fármcos ntirretrovirles. Um revision sistemátic. Med Clin (Brc). 00;11():10. Address to correspondence: JANAINA AS CASOTTI Amultório de Doençs Infeccioss (cs, fundos) HUCAM UFES, Sntos Dumont, Vitóri, Brzil Emil: [email protected] Tel: + 1, Fx: + 06 Received on: Approved in: DST J rs Doençs Sex Trnsm 011;():