Factors related to adherence to antiretroviral treatment in a specialized care facility

SUMMARY The objective of this study was to verify the level of adherence to antiretroviral treatment and its associated factors. This is a descriptive cross-sectional study based on data retrieved from medical records. To achieve this, we used a questionnaire composed of sociodemographic and clinical information recorded from patients aged between thirteen and fifty-nine years who attended a specialized service from 2007 to 2014. The chi-square test was performed to verify the association of the outcome with the categorical variables. Continuous variables were compared through the Student t-test. Thirteen variables were analyzed in the bivariate model, resulting in the selection of the following variables to the multivariate model (p<0.20) age of discovery (p=0.12), age (p=0.14), skin color (p=0.12), level of education (p=0.03), time since HIV diagnosis (p<0.001) and AIDS case (p<0.001). Among the six variables selected for the multivariate model, cases of aids (p<0.001) remained significant. We concluded that having aids decreases the probability of non-adherence to antiretroviral treatment by 92%. These results indicate that symptomatic patients have better adherence to therapy.

RESUMO O objetivo deste estudo foi verificar os níveis de adesão ao tratamento antirretroviral e os fatores associados a ela. Trata-se de um estudo descritivo de delineamento transversal baseado em levantamento de prontuários. Para tanto, foi utilizado um questionário composto de informações sociodemográficas e clínicas de pacientes com idade entre 13 e 59 anos atendidos em um serviço de atendimento especializado nos anos de 2007 a 2014. Foi realizado o teste do Qui-quadrado para verificar a associação do desfecho com as variáveis categóricas. As variáveis contínuas foram comparadas pelo teste t de "Student" (dois grupos). Treze variáveis foram analisadas no modelo bivariado, sendo selecionadas para o modelo multivariado (p<0,20): idade de descoberta (p=0,12), idade (p=0,14), cor da pele (p=0,12), escolaridade (p=0,03), tempo de diagnóstico do HIV (p<0,001) e caso de aids (p<0,001). Das seis variáveis selecionadas para o modelo multivariado, permaneceu significante o fato de o paciente ter aids (p<0,001). Concluiu-se que ter aids reduz a probabilidade de não adesão ao tratamento antirretroviral em cerca de 92%. Os resultados indicam que o indivíduo que é sintomático adere melhor à terapia.

Adherence to antiretroviral therapy among people living with HIV/AIDS in northeastern Brazil: a cross-sectional study

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.

Inequalities in HAART uptake and differential survival according to exposure category in Rio de Janeiro, Brazil / Desigualdades no acesso à HAART e diferenças de sobrevida de acordo com a categoria de exposição ao HIV no Rio de Janeiro, Brasil / Desigualdades en el consumo de la TARGA y supervivencia diferencial según la categoría de exposición en Río de Janeiro, Brasil

Abstract: Despite substantial improvement in prognosis and quality of life among people living with HIV/AIDS (PLWHA) in Brazil, inequalities in access to treatment remain. We assessed the impact of these inequalities on survival in Rio de Janeiro over a 12-year period (2000/11). Data were merged from four databases that comprise the national AIDS monitoring system: SINAN-AIDS (Brazilian Information System for Notificable Diseases; AIDS cases), SISCEL (laboratory tests), SICLOM (electronic dispensing system), and SIM (Brazilian Mortality Information System), using probabilistic linkage. Cox regressions were fitted to assess the impact of HAART (highly active antiretroviral therapy) on AIDS-related mortality among men who have sex with men (MSM), people who inject drugs (PWID), and heterosexuals diagnosed with AIDS, between 2000 and 2011, in the city of Rio de Janeiro, RJ, Brazil. Among 15,420 cases, 60.7% were heterosexuals, 36.1% MSM and 3.2% PWID. There were 2,807 (18.2%) deaths and the median survival time was 6.29. HAART and CD4+ > 200 at baseline were associated with important protective effects. Non-whites had a 33% higher risk of dying in consequence of AIDS than whites. PWID had a 56% higher risk and MSM a 11% lower risk of dying of AIDS than heterosexuals. Non-white individuals, those with less than eight years of formal education, and PWID, were more likely to die of AIDS and less likely to receive HAART. Important inequalities persist in access to treatment, resulting in disparate impacts on mortality among exposure categories. Despite these persistent disparities, mortality decreased significantly during the period for all categories under analysis, and the overall positive impact of HAART on survival has been dramatic.

Resumo: Apesar de uma melhora substancial no prognóstico e na qualidade de vida de pessoas vivendo com HIV/aids (PVHA) no Brasil, permanecem desigualdades no acesso ao tratamento. Avaliamos o impacto dessas desigualdades na sobrevida na cidade do Rio de Janeiro ao longo de 12 anos (2000/11). Os dados foram consolidados a partir de quatro bases que constituem o sistema nacional de monitoramento da aids: SINAN-aids (Sistema de Informação de Agravos de Notificação; casos de aids), SISCEL (exames laboratoriais), SICLOM (controle logístico de medicamentos) e SIM (Sistema de Informações sobre Mortalidade), usando relacionamento probabilístico. As regressões de Cox foram ajustadas para avaliar o impacto da HAART (terapia antirretroviral altivamente ativa) na mortalidade relacionada à aids entre homens que fazem sexo com homens (HSH), usuários de drogas injetáveis (UDI) e heterossexuais diagnosticados com aids entre 2000 e 2011 na cidade do Rio de Janeiro. Dos 15.420 casos, 60,7% eram heterossexuais, 36,1% HSH e 3,2% UDI. Houve 2.807 óbitos (18,2%) e a sobrevida mediana foi 6,29 anos. Houve associação significativa entre HAART e contagem de CD4+ > 200 na linha de base e importantes efeitos protetores. Comparados aos brancos, os não-brancos tiveram um risco 33% maior de morrer de aids. Os UDI tiveram um risco 56% maior, enquanto HSH tiveram um risco 11% menor de morrer de aids, comparados aos heterossexuais. Os indivíduos não-brancos, aqueles com menos de oito anos de escolaridade e UDI mostraram probabilidade mais alta de não receber HAART e de morrer de aids. No Rio de Janeiro, persistem desigualdades importantes no acesso ao tratamento, que resultam em impactos diferenciados na mortalidade de acordo com as categorias de exposição. Apesar da persistência dessas disparidades, a mortalidade diminuiu significativamente ao longo do período em todas as categorias analisadas, e o acesso à HAART teve impacto dramático no tempo de sobrevida.

Resumen: Pese a la mejora sustancial en el pronóstico y calidad de vida entre las personas que viven con VIH/SIDA (PLWHA) en Brasil, persisten las desigualdades en el acceso al tratamiento. Evaluamos el impacto de estas desigualdades en la supervivencia en Río de Janeiro, durante un período de 12 años (2000/11). Los datos fueron recabados de cuatros bases de datos que comprenden el sistema nacional de monitoreo del SIDA: SINAN-SIDA (Sistema de Información de Agravios de Notificación; casos de SIDA), SISCEL (pruebas de laboratorio), SICLOM (sistema dispensador electrónico), y SIM (Sistema de Información sobre la Mortalidad), usando una vinculación probabilística. Las regresiones de Cox fueron usadas para evaluar el impacto de la TARGA (terapia antirretroviral de gran actividad) en la mortalidad relacionada con el SIDA, entre hombres que tienen sexo con hombres (HSH), individuos que se inyectan drogas por vía intravenosa (PWID por sus siglas en inglés), y heterosexuales diagnosticados con SIDA, entre 2000 y 2011, en la ciudad de Río de Janeiro, RJ, Brasil. Entre 15.420 casos, un 60,7% eran heterosexuales, un 36,1% HSH y un 3,2% PWID. Hubo 2.807 (18.2%) muertes y el tiempo medio de supervivencia fue 6,29. TARGA y CD4+ > 200 en la base de referencia estuvieron asociados con efectos importantes de protección. Los no-blancos tuvieron un riesgo un 33% mayor de morir a consecuencia de SIDA que los blancos. Los PWID tuvieron un riesgo un 56% mayor, y los HSH un riesgo un 11% menor, de morir de SIDA que los heterosexuales. Los no-blancos, con menos de ocho años de educación formal, y los PWID, eran más propensos a morir de SIDA y menos a recibir TARGA. Existen importantes inequidades en el acceso al tratamiento, resultando en efectos dispares en la mortalidad entre las diferentes categorías exposición. A pesar de estas persistentes disparidades, la mortalidad decreció significativamente durante el periodo para todas las categorías bajo análisis, y el impacto general positivo del TARGA en la supervivencia había sido importantísimo.

Treatment adherence in patients living with HIV/AIDS assisted at a specialized facility in Brazil

Abstract INTRODUCTION: In the 1990s, Brazil adopted a public policy that allowed for universal, free access to antiretroviral therapy (ART). Since then, treatment adherence has become a new challenge for administrators of sexually transmitted disease/acquired immunodeficiency syndrome (STD/AIDS) policies. This study quantified adherence to ART and verified whether there is an association between sociodemographic variables and clinical/laboratory data in human immunodeficiency virus (HIV)-infected patients. METHODS: This was a cross-sectional, exploratory study with a quantitative approach that was conducted over 8 months. The target population contained patients who were assisted at the ambulatory care facility specialized in STD/AIDS of a medium-size city located in Northwest São Paulo. In order to verify the level of adherence to ART, a validated CEAT-VIH (Assessment of Adherence to Antiretroviral Therapy Questionnaire) questionnaire was used. Sociodemographic aspects and clinical/laboratory data were obtained from the medical records. The results were analyzed using the Student's t-test and Pearson's coefficient. RESULTS Herein, 109 patients were interviewed, 56% of whom were male. The age of the population ranged 18-74 years (mean 45.67 years). Adherence to ART was classified as insufficient in 80.7% of cases. There was an association between ART adherence and presence of symptoms and/or opportunistic infection (p=0.008) and economic status (p<0.001). CONCLUSIONS: Adherence to ART among HIV carriers cared for by the public health system is low. Patients who reported a favorable economic status and those without symptoms and/or opportunistic infection demonstrated greater treatment adherence than those who needed to take more than 3 pills a day.

Adherence to antiretroviral therapy of Brazilian HIV-infected children and their caregivers

Abstract Background Successful treatment of HIV-positive children requires a high level of adherence (at least 95%) to highly active antiretroviral therapy. Adherence is influenced by factors related to the child and caregivers. Objectives To evaluate children and caregivers characteristics associated to children's adherence. Methods Cross-sectional study, from September 2013 to June 2015, comprising a sample of caregivers of perinatally HIV-infected children, in the age group of 1–12 years, under antiretroviral therapy for at least 6 months and on follow-up in two AIDS reference centers in Salvador, Bahia. Caregiver self-reports were the sole source of 4 days adherence and sociodemographic information. Study participants who reported an intake >95% of prescribed medication were considered adherents. A variable, (“Composed Adherence”), was created to better evaluate adherence. Results We included 77 children and their caregivers. 88.3% of the caregivers were female, the median age was 38.0 years (IQR 33.5–47.5), 48.1% were white or mixed, 72.7% lived in Salvador and 53.2% had no fixed income. The 4 days child's adherence was associated only to caregivers that received less than a minimum salary (p < 0.05), 70.1% of the caregivers had less than four years of formal education, 81.8% were children's relative and 53.2% of the caregivers were HIV positive. The caregiver's pharmacy refill, long-term adherence and 4 days adherence, were significantly associated with composed adherence (p < 0.05). Child's long-term adherence was strongly associated to the 4 days child's adherence referred by caregiver (p < 0.001). Conclusions Our results suggest the need of improvement in HIV-infected children adherence, through reinforcement of the caregivers own adherence.

The influence of depressive symptoms and substance use on adherence to antiretroviral therapy. A cross-sectional prevalence study / A influência dos sintomas depressivos e do uso de substâncias na adesão à terapia antirretroviral. Um estudo transversal de prevalência

CONTEXT AND OBJECTIVE: Adherence to antiretroviral treatment (ART) is not a stable condition, but is dynamic, like mental conditions. The aim of this study was to examine whether non-adherence to ART is related to demographic and immunological variables, substance use and presence of depressive symptoms. DESIGN AND SETTING: This was a cross-sectional prevalence study carried out at a public AIDS treatment center in the city of São Paulo, Brazil, between July 2006 and January 2007. METHODS: 438 patients on regular ART schedules with recent laboratory tests answered a demographic questionnaire, questions about substance use, the Hamilton Depression Rating Scale (HDRS) and the Simplified Medication Adherence Questionnaire (SMAQ). RESULTS: The prevalence of non-adherence over the past three months (a pattern of treatment interruption) was 46.3%, and 27.2% also reported this in the past week (a pattern of missed doses). ART interruption was significantly related to older age, lower CD4+ cell count and homosexual/bisexual transmission. The pattern of missed doses was significantly related to younger age, higher HDRS scores and higher viral load of RNA HIV. CONCLUSION: ART interruption may reflect recall errors and changes to the Brazilian demographic characteristics of HIV infection. The missed doses may reflect lifestyle characteristics of younger individuals. Attendance for HIV-positive individuals, particularly younger patients, should involve interventions and counseling in relation to the presence of depressive symptoms. .

CONTEXTO E OBJETIVO: Adesão ao tratamento antirretroviral (TARV) não é uma condição estável, mas dinâmica, como os transtornos mentais. O objetivo deste estudo foi verificar se a não adesão ao TARV relaciona-se às variáveis demográficas e imunológicas, ao uso de substâncias e à presença de sintomas depressivos. DESENHO E LOCAL: Este estudo transversal de prevalência foi realizado em um serviço público para tratamento de pessoas HIV-positivas na cidade de São Paulo, Brasil, entre julho 2006 e janeiro 2007. MÉTODOS: 438 pacientes em regime regular de TARV, que tinham exames laboratoriais recentes, responderam a questionário demográfico, questões sobre uso de substâncias, Escala de Hamilton para Depressão (HAM-D) e Questionário Simplificado de Adesão à Medicação (QSAM). RESULTADOS: A prevalência de não adesão nos últimos três meses (um padrão de interrupção de tratamento) foi de 46,3% e de 27,2% na última semana (um padrão de perda de doses). A interrupção do TARV relacionou-se significativamente a maior idade, menor contagem de células CD4+ e contágio homo/bissexual, enquanto o padrão de perda de doses relacionou-se significativamente com idade mais jovem, pontuação mais alta na HAM-D e maior carga viral de RNA HIV. CONCLUSÃO: A interrupção do TARV pode refletir erros de memória e mudanças nas características demográficas brasileiras da infecção por HIV. A perda de doses pode refletir aspectos de estilo de vida de indivíduos mais jovens. O atendimento de indivíduos HIV-positivos, particularmente os mais jovens, deve envolver intervenções e aconselhamento em relação à presença de sintomas depressivos. .

Evaluación del acceso a antirretrovirales en personas viviendo con VIH/SIDA bajo la Ley chilena de garantías explícitas en salud, 1984-2018 / Evaluation of the access to antiretrovirals by people living with hiv/aids under the chilean law of explicit health guarantees, 1984-2018

INTRODUCCIÓN: Las intervenciones estructurales que garantizan el tratamiento antirretroviral (TARV) en la prevención combinada se proponen para cerrar la brecha entre el testeo y el tratamiento, manteniendo a las personas en el continuo de atención. MATERIALES Y MÉTODOS: Experimento natural que utiliza la Ley 19.966 de 2005 que otorga tratamiento y protección financiera a las personas viviendo con VIH/sida (PVVS). Se emplearon datos oficiales agregados del Ministerio de Salud de Chile. Se utilizó un diseño de series de tiempo interrumpidas para determinar el efecto de la intervención en el acceso a antirretrovirales, la morbimortalidad y los casos de sida. Además, se evaluó el impacto de la Ley con un pronóstico empleando un modelo autorregresivo de media móvil (ARIMA), a fin de contrastarlo con los casos observados. RESULTADOS: Después del 2005, se incrementó anualmente el número de PVVS en TARV (2268; IC 95%: 1502,23-3034,31), las defunciones por sida disminuyeron (-17,6; IC 95%: -31,3- -3,8) y los egresos hospitalarios aumentaron (70,86; IC 95%: 9,13-132,59). El pronóstico señaló que, en ausencia de la Ley, de manera estimada 99 321 PVVS (P<0,001) no hubiesen accedido a TARV y se hubiesen presentado 657 casos más de sida (P<0,001). DISCUSIÓN: Con la Ley GES se logró un aumento sustancial del acceso de las PVVS al TARV y una disminución en su morbimortalidad vinculada al incremento en la cobertura. No obstante, la disminución de los casos de sida estaría por debajo de lo esperado debido a brechas en el continuo de atención de las PVVS.

INTRODUCTION: Structural interventions that guarantee antiretroviral treatment (ART) in com-bination prevention are proposed to bridge the gap between testing and treatment, keeping people on the continuum of care. MATERIALS AND METHODS: A experiment that applies Law 19.966 of 2005 that grants treatment and financial protection to people living with HIV/AIDS (PLWHA) was used. Aggregated offi-cial data from the Chilean Ministry of Health were used. An interrupted time-series design was used to determine the effect of the intervention on antiretroviral access, morbidity and mortality, and AIDS cases. Additionally, the impact of the Law was evaluated with projections using an autoregressive moving average model (ARIMA), to contrast it with the observed cases. RESULTS: After 2005, the number of PLWHA on ART increased annually (2,268; 95% CI: 1502,23-3034,31), deaths from AIDS decreased (-17.6; 95% CI: -31,3- -3,8) and hospital discharges increased (70.86; 95% CI: 9.13-132.59). The projections indicated that, in the absence of the Law, an estimate of 99 321 PLWHA (P<0.001) would not have accessed ART and there would have been 657 more cases of AIDS (P<0.001). DISCUSSION: The GES Law achieved a substantial increase in PLWHA access to ART and a de-crease in their morbidity and mortality linked to the increase in coverage. However, the decline in AIDS cases would be lower than expected due to gaps in the continuum of care for PLWHS.

Adesao ao tratamento antirretroviral: assistencia integral baseada no modelo de atencao as condicoes cronicas / Adherencia al tratamiento antirretroviral: atención integral basada en el modelo de atención a las condiciones crónicas / Adherence to antiretroviral treatment: comprehensive care based on the care model for chronic conditions

OBJECTIVE: To evaluate the adherence to antiretroviral therapy (ART), identifying possible interventions based on the Care Model for Chronic Conditions. METHODS: Observational, quantitative, cross-sectional study, involving 215 people with HIV/aids using antiretroviral drugs, between March and June 2012, in Fortaleza, Ceará. From the specific adherence questionnaire, we used nine questions for discussion in the light of the Care Model for Chronic Conditions (MACC). RESULTS: 35.4% failed to adhere to medication at least once. In view of the MACC, gaps were identified, such as the need for more professional intervention, showing possibilities to apply new strategies, such as self-care actions, motivational interviews, operative group and others. CONCLUSION: A significant percentage of non-adherence to ART was found, whose interventions are still incipient. Actions based on the MACC can favor comprehensive care for patients with HIV/aids.

O objetivo deste estudo foi avaliar a adesão à terapia antirretroviral (TARV), identificando possibilidades de intervenções embasadas no modelo de atenção às condições crônicas. MÉTODOS: Estudo observacional, quantitativo, transversal, desenvolvido com 215 pessoas com HIV/ AIDS em uso de antirretrovirais, entre março e junho de 2012, em Fortaleza, Ceará. De um questionário específico para avaliar a adesão utilizaram-se nove quesitos para discussão à luz do Modelo de Atenção às Condições Crônicas (MACC). RESULTADOS: 35,4% das pessoas estudadas deixaram de aderir ao tratamento pelo menos alguma vez, por se sentirem melhor/pior, ou tristes/deprimidas. Sob a luz do MACC, foram identificadas lacunas, como necessidade de mais intervenção profissional, evidenciando possibilidades de aplicar novas estratégias, como ações para o autocuidado, entrevista motivacional, grupo operativo, e outras. CONCLUSÃO: Constatou-se que há um percentual significativo de não adesão à TARV, cujas intervenções ainda são incipientes, e que ações baseadas no MACC podem favorecer uma assistência totalitária aos pacientes com HIV/AIDS.

OBJETIVO: Evaluar la adherencia a la terapia antirretroviral (TARV), identificando las posibles intervenciones basadas en el modelo de atención de las condiciones crónicas. MÉTODOS: Estudio observacional, cuantitativo, transversal, desarrollado con 215 personas con VIH/SIDA con medicamentos antirretrovirales, entre marzo y junio de 2012, en Fortaleza, Ceará. De un cuestionario específico para valorar la adherencia, se utilizaron nueve preguntas para su discusión a la luz del Modelo de Atención a las Condiciones Crónicas (MACC). RESULTADOS: Se observó que 35,4% de los pacientes dejaron de adherir a la medicación por lo menos una vez. A la luz del MACC, fueron identificadas deficiencias, como la necesidad de más intervención profesional, mostrando las posibilidades de implementar nuevas estrategias, como las acciones de autocuidado, entrevista motivacional, grupo operativo y otros. CONCLUSIÓN: Se encontró un porcentaje significativo de no adherencia al tratamiento antirretroviral, cuyas intervenciones son aún incipientes y las acciones basadas en el MACC pueden.

Gender differences in non-adherence among Brazilian patients initiating antiretroviral therapy

OBJECTIVE: We conducted a study to identify gender differences in factors associated with the first episode of non-adherence in the 12 months following the first antiretroviral prescription. METHODS: A concurrent prospective study of patients initiating antiretroviral therapy in Brazil was conducted from 2001-2002. The self-reported measurement of adherence was defined as an intake of less than 95% of the prescribed number of doses. Only the first occurrence of non-adherence was considered in this analysis. All analyses were stratified by gender. A Cox proportional hazard model was used to estimate the risk of non-adherence, and the time to non-adherence was estimated using the Kaplan-Meier method. RESULTS: The cumulative incidence of non-adherence was 34.6% (29.7% and 43.9% among men and women, respectively; p=0.010). Marital status (being married or in stable union; p=0.022), alcohol use in the month prior to the baseline interview (p=0.046), and current tobacco use (p=0.005) increased the risk of non-adherence among female participants only, whereas a self-reported difficulty with the antiretroviral treatment was associated with non-adherence in men only. For both men and women, we found that a longer time between the HIV test and first antiretroviral therapy prescription (p=0.028) also presented an increased risk of non-adherence. CONCLUSIONS: In this cohort study, the incidence of non-adherence was 1.5 times greater among women compared to men. Our results reinforce the need to develop interventions that account for gender differences in public referral centers. Additionally, we emphasize that, to achieve and maintain appropriate adherence levels, it is important to understand the barriers to seeking and utilizing health care services. .

Usefulness of pharmacy dispensing records in the evaluation of adherence to antiretroviral therapy in Brazilian children and adolescents

INTRODUCTION: Adherence, which is crucial to the success of antiretroviral therapy (HAART), is currently a major challenge in the care of children and adolescents living with HIV/AIDS. OBJECTIVE: To evaluate the prevalence of nonadherence to HAART using complementary instruments in a cohort of children and adolescents with HIV/AIDS followed in a reference service in Campinas, Brazil. METHODS: The level of adherence of 108 patients and caregivers was evaluated by an adapted standardized questionnaire and pharmacy dispensing records (PDR). Non-adherence was defined as a drug intake lower than 95% (on 24-hour or seven-day questionnaires), or as an interval of 38 days or more for pharmacy refills. The association between adherence and clinical, immunological, virological, and psychosocial characteristics was assessed by multivariate analysis. RESULTS: Non-adherence prevalence varied from 11.1% (non-adherent in three instruments), 15.8% (24-hour self-report), 27.8% (seven-day self-report), 45.4% (PDR), and 56.3% (at least one of the outcomes). 24-hour and seven-day self-reports, when compared to PDR, showed low sensitivity (29% and 43%, respectively) but high specificity (95% and 85%, respectively). In multivariate analysis, medication intolerance, difficulty of administration by caregiver, HAART intake by the patient, lower socioeconomical class, lack of virological control, missed appointments in the past six months, and lack of religious practice by caregiver were significantly associated with non-adherence. CONCLUSION: A high prevalence of HAART non-adherence was observed in the study population, and PDR was the most sensitive of the tested instruments. The instruments employed were complementary in the identification of non-adherence.

Terapia intensiva y sida: cambios en la era del TARGA / Intensive care and AIDS: changes in the era of HAART

Analizar las características de la población de pacientes HIV positivos bajo TARGA o con CD4 mayor a 200 mm3 admitidos en una unidad de cuidados intensivos, en comparación con la población de pacientes HIV positivos sin control ni tratamiento.