RESUMO
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.
Assuntos
Humanos , Masculino , Feminino , Adolescente , Adulto , Adulto Jovem , Infecções por HIV/tratamento farmacológico , Fármacos Anti-HIV/uso terapêutico , Terapia Antirretroviral de Alta Atividade/estatística & dados numéricos , Adesão à Medicação/estatística & dados numéricos , Cooperação e Adesão ao Tratamento/estatística & dados numéricos , Brasil/epidemiologia , Atitude Frente a Saúde , Infecções por HIV/epidemiologia , Demografia/estatística & dados numéricos , Prevalência , Estudos Transversais , Inquéritos e Questionários , Terapia Antirretroviral de Alta Atividade/psicologia , Adesão à Medicação/psicologia , Cooperação e Adesão ao Tratamento/psicologiaRESUMO
Determining the prevalence and type of antiretroviral (ARV) resistance among ARV-naïve individuals is important to assess the potential responses of these individuals to first-line regimens. The prevalence of primary resistance and the occurrence of recent infections among individuals with human immunodeficiency virus (HIV)/acquired immune deficiency syndrome (AIDS) were identified among recently diagnosed patients at five sexually transmitted disease/AIDS testing and counselling centres in the metropolitan region of Recife (RMR), Pernambuco, Brazil, between 2007-2009. One-hundred and eight samples were analysed using the Calypte® BED assay. Males predominated (56%), as did patients aged 31-50 years. Twenty-three percent presented evidence of a recent HIV infection. The median CD4+ T lymphocyte count was 408 cells/mm³ and the median viral load was 3.683 copies/mL. The prevalence of primary resistance was 4.6% (confidence interval 95% = 1-8.2%) based on criteria that excluded common polymorphisms in accordance with the surveillance drug resistance mutation criteria. The prevalence of resistance to non-nucleoside reverse transcriptase, nucleoside/nucleotide reverse transcriptase and protease inhibitors were 3.8%, 1.5% and 0.8%, respectively. Fifty-seven percent of strains were from clade B, 37.7% were clade F and 3.1% were clade C; there were no statistically significant differences with respect to resistance between clades. Recent infection tended to be more common in men (p = 0.06) and in municipalities in the south of the RMR (Jaboatão dos Guararapes and Cabo de Santo Agostinho) (p = 0.046). The high prevalence of recent infection and the high prevalence of non-B strains in this poor Brazilian region merit further attention.
Assuntos
Adulto , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Farmacorresistência Viral/genética , Infecções por HIV/virologia , Protease de HIV/genética , Transcriptase Reversa do HIV/genética , HIV-1 , Mutação/genética , Fármacos Anti-HIV/uso terapêutico , Genótipo , Infecções por HIV/tratamento farmacológico , Infecções por HIV/epidemiologia , HIV-1 , Prevalência , Inibidores de Proteases/uso terapêutico , RNA Viral/genética , Inibidores da Transcriptase Reversa/uso terapêutico , Fatores Socioeconômicos , População Urbana , Carga ViralRESUMO
The BED capture enzyme immunoassay test makes it possible to determine whether individuals were recently infected with HIV. OBJECTIVE: In this study, the overall HIV and recent infections prevalences were determined at five Voluntary Counseling and Testing (VCT) centers, in the Metropolitan Region of Recife, Northeastern of Brazil. MATERIAL AND METHODS: A cross-sectional study was conducted among users of five VCTs in the metropolitan region of Recife between July 2007 and April 2009. Out of the individuals who tested positive for HIV, 169 were analyzed to assess the prevalence of recent infection by means of the BED-CEIA (BED-Calypte®). RESULTS: Out of 46,696 individuals tested 916 (1.96%) turned out positive for HIV infection The highest prevalence was in Recife (3.9%). The prevalence was higher among males (3.93%), and men who have sex with men (MSM) (12.4%). The frequency of recent infections among the 169 subjects evaluated was 23.7%. Recent infections were more common among individuals under 25 years of age. There was slight predominance of men and higher frequency of heterosexuals in both groups, but still a significant portion of MSM (33%). Subtype B predominated, followed by a high proportion of subtype F. CONCLUSIONS: Recent infection occurs mainly among young individuals and heterosexuals, despite a significant proportion of recent infection among MSM. These results suggest that preventive actions aimed at the MSM community remains a challenge and efforts focusing this group should continue to be a priority.