Adherence to antiretroviral therapy during HIV infection, a multidisciplinary approach

Since HIV infection has become a chronic disease, antiretroviral therapy is now used on a long-term basis. Response to treatment is conditioned by numerous inter-dependent factors, including non-compliance, which can result in failure of the therapeutic regimen. Although compliance is crucial for long-term efficacy of the treatment, it is a dynamic factor, and therefore difficult to evaluate. This literature review proposes a multidisciplinary approach to treatment adherence during HIV infection, and deals with the following questions: how should adherence and non-adherence be defined? How are they correlated to the treatment response? How is adherence measured in trials and cohorts, as well as in clinical practice? By what factors is it influenced? What tools can be implemented to improve adherence? The interaction between adherence and response to antiretroviral therapy requires communication between clinicians, healthcare providers, patients, virologists, pharmacologists, and the companies responsible for developing drugs. The pharmaceutical industry must sustain its efforts to ensure a balance between demands for efficacy and adherence when developing new drugs. And the methods implemented by numerous healthcare teams plead in favour of a dynamic approach to adherence, with the active participation of all.     

Pediatrie HIV Adherence

Summary

Providers working with children living with HIV strive to achieve “good adherence,” often viewed only as consistent pill taking by the infected child. This goal, while important, needs to be expanded with a thorough examination of the many biopsychosocial factors impacting the HIV affected family. The complexity of the issues affecting adherence to a pediatrie HIV medical regimen can overwhelm both the practitioner and the patient. By utilizing a developmental framework and emphasizing the critical importance of the relationship between provider, patient and family, the authors (both of whom are social workers who have worked over a period of many years with children and families living with terminal and serious chronic illnesses) describe a developmental approach that includes comprehensive assessment to address the multiple challenges faced by individuals and families they have worked with.     

Communication Strategies to Improve HIV Treatment Adherence

Although antiretroviral therapy has increased the survival of HIV-positive patients, traditional approaches to improving medication adherence have failed consistently. Acknowledging the role of communication in health behavior, we conducted a qualitative study to learn about patients' HIV treatment adherence experiences and to identify which communication strategies might influence adherence. Findings indicate that five constructs – cultural beliefs/language, stigma, cues to action, self-efficacy, and mood state – are potentially modifiable by improved communication. Results will be used to create a direct marketing campaign targeted to HIV-infected patients.     

HIV/AIDS患者高效抗逆转录病毒治疗依从性的研究进展

高效抗逆转录病毒治疗(HAART)可以有效地延缓HIV/AIDS患者的疾病进程,改善生活质量,但HAART要求近乎完美的依从性。其依从性的研究在西方发达国家开展较多,但在我国的相关研究不多。文章就国际上HIV/AIDS患者HAART依从性的评价方法及影响因素的研究进展进行了综述。     

基于健康信念理论的抗病毒治疗依从管理研究

目的 了解艾滋病低流行地区免费抗病毒治疗依从现状,为探索适宜的治疗管理模式提供参考.方法 采用意图抽样法,以吉林省吉林市患者居住集中的船营区和永吉县为调查点,通过结构式问卷调查53例患者的社会人口学特征、治疗基本情况、近期服药依从情况、遵医嘱服药信念、医疗卫生服务与医患关系.结果 53例患者中3例中断治疗,正在服药的50例近1周服药依从率为82.0％.患者感知遵医嘱服药的利益、感知不依从后果的威胁和自我效能得分均较高,除3例停药者外目前均用药盒管理服药,73.6％的患者自述已养成按时服药习惯,88.7％的患者报告有人督促和提醒服药.结论 研究地区接受免费抗病毒治疗患者的依从性较好,当地推行三级督导管理制度成为帮助患者保持服药依从的重要促进因素.     

Zidovudine therapy in combination with intravenous immunoglobulin in HIV infected children.

There is little published data on concomitant use of zidovudine and intravenous immunoglobulin (IV IgG). In this paper we review our experience of four HIV-1 infected children treated with zidovudine for periods of 19-33 months (mean 26.5 months) subsequent to starting IV IgG for period of 18-20 months (mean 19 months). In these children the only clear benefit we found was in one child who had developed HIV encephalopathy which resolved after starting zidovudine. The respective roles of zidovudine and intravenous immunoglobulin in HIV-1 infected children need to be clarified in larger comparative trials.     

Socioeconomic Factors in Adherence to HIV Therapy in Low- and Middle-income Countries

It is not clear what effect socioeconomic factors have on adherence to antiretroviral therapy (ART) among patients in low- and middle-income countries.  We performed a systematic review of the association of socioeconomic status (SES) with adherence to treatment of patients with HIV/AIDS in low- and middle-income countries. We searched electronic databases to identify studies concerning SES and HIV/AIDS and collected data on the association between various determinants of SES (income, education, occupation) and adherence to ART in low- and middle-income countries. From 252 potentially-relevant articles initially identified, 62 original studies were reviewed in detail, which contained data evaluating the association between SES and adherence to treatment of patients with HIV/AIDS. Income, level of education, and employment/occupational status were significantly and positively associated with the level of adherence in 15 studies (41.7%), 10 studies (20.4%), and 3 studies (11.1%) respectively out of 36, 49, and 27 studies reviewed. One study for income, four studies for education, and two studies for employment found a negative and significant association with adherence to ART. However, the aforementioned SES determinants were not found to be significantly associated with adherence in relation to 20 income-related (55.6%), 35 education-related (71.4%), 23 employment/occupational status-related (81.5%), and 2 SES-related (100%) studies. The systematic review of the available evidence does not provide conclusive support for the existence of a clear association between SES and adherence to ART among adult patients infected with HIV/AIDS in low- and middle-income countries. There seems to be a positive trend among components of SES (income, education, employment status) and adherence to antiretroviral therapy in many of the reviewed studies.Key words: Antiretroviral therapy, highly active; Education; Employment; Income; Occupations; Social class     

A Qualitative Study of Literacy and Patient Response to HIV Medication Adherence Questionnaires

ABSTRACT

The purpose of this study was to elicit patient feedback regarding the perceived clarity and level of difficulty associated with self-report human immunodeficiency virus (HIV) medication adherence measurement tools. HIV-infected patients from clinics in Shreveport, Louisiana, and Chicago, Illinois, were recruited to participate in four focus group discussions. Three groups consisted of patients with limited literacy skills (<ninth-grade reading ability), and one group contained patients with adequate literacy skills (≥ninth-grade reading ability). Five themes emerged: (1) respondent understanding of the term “adherence,” (2) recall, (3) question format, (4) visual aids, and (5) instrument administration. Participants struggled to define adherence, relied on visual cues to identify medications, and had a short recall time frame for missed doses (≤3 days). Most preferred simple question formats and for their physician to assess adherence orally. Patients receiving treatment for HIV infection, especially those with limited literacy skills, may find it difficult to respond to existing HIV medication adherence questionnaires.     

Adherence to the Mediterranean diet is associated with a lower risk of body-shape changes in Croatian patients treated with combination antiretroviral therapy

Lipoatrophy and lipohypertrophy have been observed during long-term combination antiretroviral therapy (CART). We investigated whether consumption of a Mediterranean diet is associated with lower risk of body-shape changes in Croatian patients treated with CART. Between May 2004 and June 2005, we conducted a cross-sectional study of 136 adults with HIV-1 infection who were treated with CART for at least 1 year. Lipoatrophy and lipohypertrophy were assessed by self-report and physical examination. Adherence to a Mediterranean diet was determined by a 150-item questionnaire; a 0–9 point diet scale was created that stratified respondents as having low adherence (<4 points) and moderate to high adherence (≥4 points). Lipoatrophy was present in 41% and lipohypertrophy in 32% of participants. Non-smokers with a dietary score ≥4 had the lowest risk for lipoatrophy. Stavudine use, female gender, and duration of CART were also independently associated with a higher risk of lipoatrophy. A dietary score of ≥4 was associated with lower risk of lipohypertrophy (adjusted OR 0.3, 95% CI 0.1–0.7; P = 0.012). Female gender, longer duration of CART, and longer known duration of HIV infection prior to CART were also independently associated with higher risk of lipohypertrophy. In conclusion, Croatians who did not smoke and moderately or highly adhered to the Mediterranean diet were least likely to have the clinical syndrome of lipoatrophy. Moderate to high adherence to a Mediterranean diet was associated with a lower risk of lipohypertrophy.     

Adherence to highly active antiretroviral therapy in Spain. A meta-analysis

Objectives

To estimate the percentage of adherence to highly-active antiretroviral therapy (HAART) in Spanish observational studies and to identify the variables associated with adherence.

Methods

Seven electronic databases were used to locate the studies. Six inclusion criteria were established. Two coders codified the variables independently. Intercoder reliability was calculated. Publication bias was analyzed through the Begg, Egger and Trim and Fill tests. Homogeneity was evaluated using the Q test and the l² index. A random effects model was assumed to estimate both the overall percentage of adherence and to explain heterogeneity.

Results

This meta-analysis included 23 observational studies, yielding a total of 34 adherence estimates. The sample was composed of 9,931 HIV-positive individuals (72% men) older than 18 years under treatment with HAART. The percentage of patients adhering to an intake of >90% of the prescribed antiretroviral drugs was 55%. Wide heterogeneity was detected (I² = 91.20; 95%CI: 88.75-93.13). Adherence was mainly measured using a single strategy (47.8%), the most widely used being self-report (48.7%). In the univariate analysis, the following factors were significant: infection stages A (β = 0.68, p <0.001) and B (β = -0.56, p <0.01), viral loads >200 copies/ml (β = -0.41, p <0.05) and <200 (β = 0.39, p <0.05), and university education (β = -0.66, p<0.05).

Conclusions

The overall percentage of adherence was 55%, although this value may be an overestimate. Adherence was associated with infection stage A and with a viral load of <200 copies/ml.     

To work or not to work: combination therapies and HIV

The authors describe the labor force experiences of people living with HIV and AIDS (PHAs) who are taking combination therapies using information from in-depth interviews conducted in 1999 and 2000 in the Windsor and Essex County region of Canada with 35 PHAs. They analyze labor force experience contextually, setting it within the contexts of personal illness experience (including disease trajectory and treatment history), workplace structure and discrimination, the labor market, and the structure of health and social service systems. Barriers to returning to or remaining in the labor force are numerous and require a specific commitment to overcome. Existing workplace and government policies and programs and labor market conditions impede labor force participation for PHAs who have recovered from serious illness and are now able and willing to work.