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HIV INFECTION

Factors Affecting Patient Adherence to Highly Active Antiretroviral Therapy

Clinical Pharmacist, Department of Pharmacy, University Hospital Doce de Octubre, Madrid, Spain

Mercedes Campo, PharmD PhD

Clinical Pharmacist, Department of Pharmacy, University Hospital Doce de Octubre

Jesus Martín, MD PhD

Family Physician, Research Unit, 11th Health Area, Madrid

Clara Fernández-Shaw, PharmD PhD

Clinical Pharmacist, Department of Pharmacy, University Hospital Doce de Octubre

Federico Pulido, MD PhD

HIV Clinical Specialist, HIV Unit, Department of Internal Medicine, University Hospital Doce de Octubre

Rafael Rubio, MD PhD

HIV Clinical Specialist, HIV Unit, Department of Internal Medicine, University Hospital Doce de Octubre

Reprints: Ismael Escobar PharmD, Department of Pharmacy, University Hospital Doce de Octubre, Crta. Andalucía, Km 5,400. 28047 Madrid, Spain, FAX 34-91 3908005, E-mail simonescobar{at}airtel.net

OBJECTIVE: To determine the clinical and demographic variables related to adherence to highly active antiretroviral therapy (HAART) in patients treated in our hospital and identify the characteristics of nonadherent patients.

METHODS: Outpatients receiving treatment with HAART (n = 283) were asked about variables related to adherence and to complete the APGAR (family support), State-Trait Anxiety questionnaire (STAI) (emotional situation), and IAS (social support) questionnaires. Patients were classified in 2 groups depending on whether adherence was 95% or <95%. Adherence was defined as the percentage of dosage forms prescribed that were obtained by the patient at the hospital pharmacy. A multivariate analysis was created to analyze how each significant variable affected adherence.

RESULTS: Our data showed significant nonadherence for patients with the following factors: low level of education, unemployed, emotional situation, and abuse of substances including intravenous drugs. All significant variables were included in a logistic regression model to optimize the results. This model considered 4 variables: age (95% CI 0.89 to 0.99), number of antiretroviral drugs (95% CI 1.05 to 2.11), STAI Anxiety/Trait test (95% CI 2.02 to 6.02), and abuse of drugs (95% CI 1.20 to 3.95).

CONCLUSIONS: We recommended special intervention to reinforce adherence for younger patients, patients taking a high number of antiretroviral drugs, those who have a history of intravenous drug use, and those with high anxiety status.

Key Words: adherence, antiretroviral treatment, adherence

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