ABSTRACT
OBJECTIVES: The purpose of this case-control study was to verify the association between single nucleotide polymorphisms (SNPs) in genes encoding drug transporters related to tenofovir disoproxil fumarate (TDF) and proximal renal tubular dysfunction (PRTD), and the association between PRTD and clinical characteristics. METHODS: The 'cases' met the diagnostic criteria for PRTD, determined by the presence of two or more of the following abnormalities: non-diabetic glycosuria, metabolic acidosis, increased uric acid and phosphorus excretion, decreased tubular phosphorus reabsorption and ß2-microglobulinuria. We analyzed eight SNPs in ABCC2, ABCC4, ABCC10 and SLC28A2 genes. Genotyping was performed using real-time PCR. RESULTS: Of the 204 people living with HIV, 38 (18.6%) met the criteria for diagnosis of PRTD and 131 were male (64.2%), with a mean age of 49 years and a history of previous antiretroviral therapy for an average of 5 years. In the multivariate analysis, older individuals, TDF use, protease inhibitor, antihypertensives and anticonvulsants were associated with a risk of developing PRTD. Increased excretion of ß2microglobulin was associated with the A/G genotype of rsCC8187710 from ABCC2 ( P = 0.003) and the following genotypes of ABCC4 SNPs: A/G from rs1059751 ( P = 0.023), G/G from rs1059751 ( P = 0.030) and C/C of rs3742106 ( P = 0.041). The increase in the fraction of excreted phosphorus was associated with the C/T genotype of SNCC rsP40037 from ABCC2 ( P = 0.0041). CONCLUSIONS: The results indicate an important relationship between SNPs associated with these markers and changes in proximal renal tubule function, and thus support their use as biomarkers for the early detection of PRTD risk.
Subject(s)
Acquired Immunodeficiency Syndrome , Anti-HIV Agents , HIV Infections , Male , Humans , Middle Aged , Female , Tenofovir/adverse effects , Anti-HIV Agents/adverse effects , Acquired Immunodeficiency Syndrome/drug therapy , Pharmacogenomic Testing , Case-Control Studies , HIV Infections/drug therapy , HIV Infections/genetics , Multidrug Resistance-Associated Protein 2 , Phosphorus/therapeutic useABSTRACT
ABSTRACT BACKGROUND: Nonadherence to antiretroviral therapy (ART) may lead to viral replication and development of antiretroviral resistance. OBJECTIVE: To identify the factors associated with nonadherence to ART among people living with the human immunodeficiency virus (HIV)/acquired immunodeficiency syndrome (AIDS) (PLWHA). DESIGN AND SETTING: Cross-sectional study in a tertiary-level hospital in northeastern Brazil. METHODS: Intake of less than 90% of the antiretroviral drugs prescribed in the last week prior to the interview was defined as nonadherence. Intake was evaluated using a questionnaire. Descriptive and multivariate analyses were conducted on the study population, with estimation of the respective odds ratios and 95% confidence intervals. RESULTS: The prevalence of nonadherence was 28.4%. Significant associations were found regarding the following variables: age less than 35 years, smoking, sedentary lifestyle, lack of medication and lack of knowledge regarding the patient's HIV status, on the part of the patient's partner or family. CONCLUSIONS: Encouragement of adherence to antiretroviral therapy is one of the fundamental pillars of treatment for HIV-infected patients. The high proportion of nonadherence (28.4%) and the predictive factors related to this indicate that it is necessary to improve patients' adherence to antiretroviral therapy.
Subject(s)
Humans , Male , Female , Adolescent , Adult , Young Adult , HIV Infections/drug therapy , Anti-HIV Agents/therapeutic use , Antiretroviral Therapy, Highly Active/statistics & numerical data , Medication Adherence/statistics & numerical data , Treatment Adherence and Compliance/statistics & numerical data , Brazil/epidemiology , Attitude to Health , HIV Infections/epidemiology , Demography/statistics & numerical data , Prevalence , Cross-Sectional Studies , Surveys and Questionnaires , Antiretroviral Therapy, Highly Active/psychology , Medication Adherence/psychology , Treatment Adherence and Compliance/psychologyABSTRACT
BACKGROUND: Nonadherence to antiretroviral therapy (ART) may lead to viral replication and development of antiretroviral resistance. OBJECTIVE: To identify the factors associated with nonadherence to ART among people living with the human immunodeficiency virus (HIV)/acquired immunodeficiency syndrome (AIDS) (PLWHA). DESIGN AND SETTING: Cross-sectional study in a tertiary-level hospital in northeastern Brazil. METHODS: Intake of less than 90% of the antiretroviral drugs prescribed in the last week prior to the interview was defined as nonadherence. Intake was evaluated using a questionnaire. Descriptive and multivariate analyses were conducted on the study population, with estimation of the respective odds ratios and 95% confidence intervals. RESULTS: The prevalence of nonadherence was 28.4%. Significant associations were found regarding the following variables: age less than 35 years, smoking, sedentary lifestyle, lack of medication and lack of knowledge regarding the patient's HIV status, on the part of the patient's partner or family. CONCLUSIONS: Encouragement of adherence to antiretroviral therapy is one of the fundamental pillars of treatment for HIV-infected patients. The high proportion of nonadherence (28.4%) and the predictive factors related to this indicate that it is necessary to improve patients' adherence to antiretroviral therapy.
Subject(s)
Anti-HIV Agents/therapeutic use , Antiretroviral Therapy, Highly Active/statistics & numerical data , HIV Infections/drug therapy , Medication Adherence/statistics & numerical data , Treatment Adherence and Compliance/statistics & numerical data , Adolescent , Adult , Antiretroviral Therapy, Highly Active/psychology , Attitude to Health , Brazil/epidemiology , Cross-Sectional Studies , Demography/statistics & numerical data , Female , HIV Infections/epidemiology , Humans , Male , Medication Adherence/psychology , Prevalence , Surveys and Questionnaires , Treatment Adherence and Compliance/psychology , Young AdultABSTRACT
Trata-se de um estudo de corte transversal com o objetivo de investigar a não adesão ao tratamento com antiretrovirais em adultos com HIV/aids, atendidos no ambulatório do Hospital das Clínicas da UFPE e identificar os fatores associados a não adesão à terapia ARV. Os dados foram obtidos de um questionário aplicado por meio de entrevista, realizadas em 253 pacientes no período de novembro de 2012 a março de 2013. Tomou-se como não adesão, o relato de tomada de menos de 90 por cento dos medicamentos antirretrovirais prescritos na última semana anterior a entrevista. O estudo encontrou 28,5 por cento (IC 95 por cento) de não aderentes ao tratamento ARV. Os fatores associados a não adesão que apresentaram significância foram: idade de 18 a 35 anos, tabagismo, uso de drogas ilícitas, não ter religião, não fazer atividade física, ter parceiros eventuais, não conhecer o status sorológico dos parceiros, parceiros não são HIV+, não falar para alguém da família, usar esquema terapêutico básico alternativo, especiais e de resgate, viagens, ter dificuldade de ter consulta com seu médico, médico não conversa sobre seus medicamentos ARV e não pergunta ao médico quando tem dúvidas sobre seus medicamentos ARV. Os resultados sugerem o perfil do indivíduo com maior risco de interrupção do tratamento com ARV, atendido no Hospital das Clínicas da UFPE. O que possibilita a adoção de medida que aumentem a adesão observada, que venha contribuir com o estabelecimento de informações para um sistema de vigilância por meio da atenção farmacêutica integrada às atividades de uma equipe multiprofissional.
