The influence of depressive symptoms and substance use on adherence to antiretroviral therapy
a cross-sectional prevalence study
Keywords:
HIV, Depression, Medication adherence, Antiretroviral therapy, highly active, Immune systemAbstract
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 Sim-plified Medication Adherence Questionnaire (SMAQ). RESULTS: The prevalence of non-adherence over the past three months (a pattern of treatment interrup-tion) was 46.3%, and 27.2% also reported this in the past week (a pattern of missed doses). ART interrup-tion 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 char-acteristics 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.
Downloads
References
Bangsberg DR, Perry S, Charlebois ED, et al. Non-adherence to highly active antiretroviral therapy predicts progression to AIDS. AIDS. 2001;15(9):1181-3.
Wood E, Hogg RS, Yip B, et al. Effect of medication adherence on survival of HIV-infected adults who start highly active antiretroviral therapy when the CD4+ cell count is 0.200 to 0.350 x 10(9) cells/L. Ann Intern Med. 2003;139(10):810-6.
Fine RN, Becker Y, De Geest S, et al. Nonadherence consensus conference summary report. Am J Transplant. 2009;9(1):35-41.
Carrieri MP, Leport C, Protopopescu C, et al. Factors associated with nonadherence to highly active antiretroviral therapy: a 5-year follow-up analysis with correction for the bias induced by missing data in the treatment maintenance phase. J Acquir Immune Defic Syndr. 2006;41(4):477-85.
Lucas GM, Griswold M, Gebo KA, et al. Illicit drug use and HIV-1 disease progression: a longitudinal study in the era of highly active antiretroviral therapy. Am J Epidemiol. 2006;163(5):412-20.
Palepu A, Raj A, Horton NJ, et al. Substance abuse treatment and risk behaviors among HIV-infected persons with alcohol problems. J Subst Abuse Treat. 2005;28(1):3-9.
Hinkin CH, Barclay TR, Castellon SA, et al. Drug use and medication adherence among HIV-1 infected individuals. AIDS Behav. 2007;11(2):185-94.
Bouhnik AD, Préau M, Vincent E, et al. Depression and clinical progression in HIV-infected drug users treated with highly active antiretroviral therapy. Antivir Ther. 2005;10(1):53-61.
Ciesla JA, Roberts JE. Meta-analysis of the relationship between HIV infection and risk for depressive disorders. Am J Psychiatry. 2001;158(5):725-30.
Friedman H, Pross S, Klein TW. Addictive drugs and their relationship with infectious diseases. FEMS Immunol Med Microbiol. 2006;47(3):330-42.
Leserman J. Role of depression, stress, and trauma in HIV disease progression. Psychosom Med. 2008;70(5):539-45.
Klinkenberg WD, Sacks S; HIV/AIDS Treatment Adherence, Health Outcomes and Cost Study Group. Mental disorders and drug abuse in persons living with HIV/AIDS. AIDS Care. 2004;16 Suppl 1:S22-42.
National Institutes of Health. Office of AIDS Research. Advisory Council, United States. Public Health Service. Guidelines for the use of antiretroviral agents in HIV-1-infected adults and adolescents. Available from: http://aidsinfo.nih.gov/contentfiles/lvguidelines/ adultandadolescentgl.pdf. Accessed in 2014 (Jan 28).
Liu H, Golin CE, Miller LG, et al. A comparison study of multiple measures of adherence to HIV protease inhibitors. Ann Intern Med. 2001;134(10):968-77.
Carrieri P, Cailleton V, Le Moing V, et al. The dynamic of adherence to highly active antiretroviral therapy: results from the French National APROCO cohort. J Acquir Immune Defic Syndr. 2001;28(3):232-9.
Knobel H, Urbina O, González A, et al. Impact of different patterns of nonadherence on the outcome of highly active antiretroviral therapy in patients with long-term follow-up. HIV Med. 2009;10(6):364-9.
Villes V, Spire B, Lewden C, et al. The effect of depressive symptoms at ART initiation on HIV clinical progression and mortality: implications in clinical practice. Antivir Ther. 2007;12(7):1067-74.
Brigido LF, Rodrigues R, Casseb J, et al. Impact of adherence to antiretroviral therapy in HIV-1-infected patients at a university public service in Brazil. AIDS Patient Care STDS. 2001;15(11):587-93.
Melchior R, Nemes MIB, Alencar TMD, Buchalla CM. Desafios da adesão ao tratamento de pessoas vivendo com HIV/Aids no Brasil [Challenges of treatment adherence by people living with HIV/AIDS in Brazil]. Rev Saude Publica. 2007;41(supl 2):87-93.
Silva MCF, Ximenes RAA, Miranda Filho DB, et al. Fatores preditivos de não-adesão à terapia antiretroviral [Risk-factors for non-adherence to antiretroviral therapy]. Rev Inst Med Trop São Paulo. 2009;51(3):135-9.
Bonolo Pde F, Machado CJ, César CC, Ceccato MD, Guimarães MD. Vulnerability and non-adherence to antiretroviral therapy among HIV patients, Minas Gerais State, Brazil. Cad Saude Publica. 2008;24(11):2603-13.
Campos LN, Guimarães MD, Remien RH. Anxiety and depression symptoms as risk factors for non-adherence to antiretroviral therapy in Brazil. AIDS Behav. 2010;14(2):289-99.
Malta M, Magnanini MM, Strathdee SA, Bastos FI. Adherence to antiretroviral therapy among HIV-infected drug users: a meta-analysis. AIDS Behav. 2010;14(4):731-47.
Paz LC, Pereira GF, Pinto VM, et al. Nova definição de casos de sífilis congênita para fins de vigilância epidemiológica no Brasil, 2004 [New case definition of congenital syphilis for epidemiological surveillance purposes in Brazil, 2004]. Rev Bras Enferm. 2005;58(4):486-7.
Folstein MF, Folstein SE, McHugh PR. “Mini-mental state”. A practical method for grading the cognitive state of patients for the clinician. J Psychiatr Res. 1975;12(3):189-98.
Hamilton M. A rating scale for depression. J Neurol Neurosurg Psychiatry. 1960;23:56-62.
Knobel H, Alonso J, Casado JL, et al. Validation of a simplified medication adherence questionnaire in a large cohort of HIV-infected patients: the GEEMA Study. AIDS. 2002;16(4):605-13.
Nemes MI, Alencar TM, Basso CR, et al. Assessment of outpatient services for AIDS patients, Brazil: comparative study 2001/2007. Rev Saude Publica. 2013;47(1):137-46; discussion 146.
Basso CR, Helena ET, Caraciolo JM, Paiva V, Nemes MI. Exploring ART intake scenes in a human rights-based intervention to improve adherence: a randomized controlled trial. AIDS Behav. 2013;17(1):181-92.
Paterson DL, Swindells S, Mohr J, et al. Adherence to protease inhibitor therapy and outcomes in patients with HIV infection. Ann Intern Med. 2000;133(1):21-30.
Nieuwkerk PT, Oort FJ. Self-reported adherence to antiretroviral therapy for HIV-1 infection and virologic treatment response: a meta-analysis. J Acquir Immune Defic Syndr. 2005;38(4):445-8.
Nachega JB, Hislop M, Dowdy DW, et al. Adherence to nonnucleoside reverse transcriptase inhibitor-based HIV therapy and virologic outcomes. Ann Intern Med. 2007;146(8):564-73.
Price DA, Scullard G, Oxenius A, et al. Discordant outcomes following failure of antiretroviral therapy are associated with substantial differences in human immunodeficiency virus-specific cellular immunity. J Virol. 2003;77(10):6041-9.
Azar MM, Springer SA, Meyer JP, Altice FL. A systematic review of the impact of alcohol use disorders on HIV treatment outcomes, adherence to antiretroviral therapy and health care utilization. Drug Alcohol Depend. 2010;112(3):178-93.
Springer SA, Dushaj A, Azar MM. The impact of DSM-IV mental disorders on adherence to combination antiretroviral therapy among adult persons living with HIV/AIDS: a systematic review. AIDS Behav. 2012;16(8):2119-43.
Catz SL, Kelly JA, Bogart LM, Benotsch EG, McAuliffe TL. Patterns, correlates, and barriers to medication adherence among persons prescribed new treatments for HIV disease. Health Psychol. 2000;19(2):124-33.
Hendershot CS, Stoner SA, Pantalone DW, Simoni JM. Alcohol use and antiretroviral adherence: review and meta-analysis. J Acquir Immune Defic Syndr. 2009;52(2):180-202.
Rao D, Feldman BJ, Fredericksen RJ, et al. A structural equation model of HIV-related stigma, depressive symptoms, and medication adherence. AIDS Behav. 2012;16(3):711-6.
Sutin AR, Terracciano A, Milaneschi Y, et al. The trajectory of depressive symptoms across the adult life span. JAMA Psychiatry. 2013;70(8):803-11.
Nakagawa F, May M, Phillips A. Life expectancy living with HIV: recent estimates and future implications. Curr Opin Infect Dis. 2013;26(1):17-25.
Hall HI, Espinoza L, Benbow N, Hu YW; Urban Areas HIV Surveillance Workgroup. Epidemiology of HIV infection in large urban areas in the United States. PloS One. 2010;5(9):e12756.
Bangsberg DR, Hecht FM, Clague H, et al. Provider assessment of adherence to HIV antiretroviral therapy. J Acquir Immune Defic Syndr. 2001;26(5):435-42.
Simoni JM, Kurth AE, Pearson CR, et al. Self-report measures of antiretroviral therapy adherence: A review with recommendations for HIV research and clinical management. AIDS Behav. 2006;10(3):227-45.
Amico KR, Orrell C. Antiretroviral therapy adherence support: recommendations and future directions. J Int Assoc Provid AIDS Care. 2013;12(2):128-37.
Fisher JD, Fisher WA, Cornman DH, et al. Clinician-delivered intervention during routine clinical care reduces unprotected sexual behavior among HIV-infected patients. J Acquir Immune Defic Syndr. 2006;41(1):44-52.
Gardner LI, Marks G, O’Daniels CM, et al. Implementation and evaluation of a clinic-based behavioral intervention: positive steps for patients with HIV. AIDS Patient Care STDS. 2008;22(8):627-35.
