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.

Mudanças no cotidiano de mulheres vivendo com HIV: análise ambulatorial, Rj, Brasil / Changes in the quotidian of women living with HIV: ambulatorial analysis, Rio de Janeiro state, Brazil / Cambios en el cotidiano de mujeres que viven con el VIH: análisis ambulatorio, Rj, Brasil

Objective: The study's purpose has been to scrutinize the changes in women's daily life, as well as to investigate how they stand after the diagnosis of HIV/AIDS and the introduction of Antiretroviral Therapy (ART). Methods: It is a descriptive and prospective study with a qualitative approach. Semi-structured interviews were performed with twenty-two HIV positive women, who were enrolled in the immunology ambulatory of a university hospital located in the Rio de Janeiro city. This research was approved by the Research Ethics Committee (CAAE: 45955315.0.0000.5285). Results: Most women dealt positively with the changes in their daily lives after discovering the disease, looking for a way of life with quality, although they still show some difficulties in that regard. Concerning the ART, there was struggle in its beginning; however, as the time went by the adaptations occurred mainly with the family support. Conclusion: It is essential to provide better support towards women during both HIV diagnosis and treatment, so that they can improve their coping strategies

Objetivo: Investigar as mudanças no cotidiano e analisar o enfrentamento de mulheres após o diagnóstico do HIV/AIDS e a introdução da Terapia Antirretroviral (TARV). Método: Estudo descritivo e prospectivo de natureza qualitativa. Realizadas entrevistas semiestruturadas com vinte e duas mulheres HIV positivas, matriculadas no ambulatório de imunologia de um hospital universitário do Rio de Janeiro. Aprovado pelo Comitê de Ética CAAE: 45955315.0.0000.5285. Resultados: A maioria das mulheres enfrentou positivamente as mudanças no seu cotidiano após a descoberta da doença, buscando viver com qualidade, embora ainda apresentem dificuldades na retomada de suas vidas. Com relação à TARV houve dificuldade em seu início, no entanto com o passar do tempo ocorreram adaptações principalmente com o apoio da família. Conclusão: É fundamental que haja um maior apoio as mulheres durante o diagnóstico e tratamento do HIV, para que possam elaborar melhor suas estratégias de enfrentamento

Objetivo: Investigar los cambios en la rutina y hacer un análisis del enfrentamiento de mujeres tras el diagnóstico del VIH/sida y la introducción de la Terapia Antirretroviral (TARV). Método: Estudio descriptivo y prospectivo de naturaleza cualitativa. Se realizaron entrevistas semiestructuradas con veintidós mujeres VIH positivas, matriculadas en el ambulatorio inmunológico de un hospital universitario de Río de Janeiro. Aprobado por el Comité de Ética CAAE: 45955315.0.0000.5285. Resultados: La mayoría de las mujeres enfrentó positivamente los cambios en su cotidiano después del descubrimiento de la enfermedad, buscando vivir con calidad, aunque todavía presentan dificultades en la reanudación de sus vidas. En cuanto a la TARV hubo dificultad en su inicio, sin embargo con el paso del tiempo ocurrieron adaptaciones principalmente con el apoyo de la familia. Conclusión: El apoyo a las mujeres durante el diagnóstico y tratamiento del VIH es fundamental, para que puedan elaborar sus estrategias de enfrentamiento

Calidad de vida y variables psicológicas que afectan la adherencia al tratamiento anti-retroviral en pacientes mexicanos con infección por VIH/SIDA / Quality of life and psychological variables affecting adherence to antiretroviral treatment in Mexican patients with HIV/AIDS

Resumen Introducción: El tratamiento anti-retroviral (TAR) es indispensable en pacientes con infección por VIH/ SIDA; suprimir la carga viral requiere de un estricto apego a éste, por compromiso del paciente. El fracaso del TAR es primordialmente por falta de adherencia, que puede ser debida a una deficiente calidad de vida y/o a variables psicológicas. Objetivo: Determinar la calidad de vida, variables psicológicas y la adherencia al TAR, en pacientes con infección por VIH/SIDA. Material y Método: Se incluyeron 160 pacientes con diagnóstico de infección por VIH/SIDA y con TAR. Se recabaron los instrumentos MOS SF-36 y VPAD-24, una encuesta demográfica, y datos clínicos. Se hicieron asociaciones cuantitativas y cualitativas entre las variables. Resultados: La adherencia al TAR estuvo asociada con evitar comportamiento depresivo y con ausencia de adicciones. El comportamiento depresivo se encontró asociado con las adicciones. Un 87% de pacientes estaba en el rango de mejor calidad de vida. Por debajo del promedio del puntaje de salud general estuvieron masculinos, con orientación sexual HSH, solteros, en la vitalidad a los ≥ 38 años, en dolor corporal y función social a tres esquemas TAR. Conclusión: La buena adherencia al TAR estuvo asociada a evitar comportamiento depresivo y a la ausencia de adicciones y no se asoció a la calidad de vida.

Background: Antiretroviral treatment (ART) is essential in HIV/AIDS patients. Suppressing viral load requires strict adherence to ART in addition to the patient's commitment to treatment. The failure of ART is mainly due to lack of adherence, which may in turn be due to poor quality of life and/or to psychological variables. Aim: To determine the quality of life and psychological variables and adherence to ART, in patients with HIV/AIDS. Material and Method: 160 patients diagnosed with HIV/AIDS and with ART were included. The MOS SF-36 and VPAD-24 instruments, a socio-demographic survey, and clinical data were collected. Quantitative and qualitative associations were made between the variables. Results: The adherence to ART was associated with avoidance of depressive behavior and with the absence of addictions. Depressive behavior associated with addictions. 87% of patients ranked in the best quality of life. Below the average of the general health score were males, with MSM sexual orientation, single, in vitality at ≥ 38 years, in corporal pain and with social function to three ART schemes. Conclusion: Good adherence to ART was associated with avoiding depressive behavior and with non-addictions and not associated with quality of life.

Depression and adherence to antiretroviral treatment in HIV-positive men in São Paulo, the largest city in South America: Social and psychological implications

OBJECTIVES: The aim of the present study was to investigate the prevalence of depression and adherence to antiretroviral treatment in two groups of individuals: men who have sex with men (MSM) and men who have sex with women (MSW). METHODS: Two hundred and sixteen participants (MSM=116; MSW=100) who visited the Clinics Hospital of the School of the Medicine of the University of São Paulo completed two independent surveys (the BECK Depression Inventory and an adherence self-declared questionnaire) to evaluate their depression status and adherence to antiretroviral treatment, respectively. RESULTS: The study highlighted a positive relationship between depression and low adherence to Highly Active Antiretroviral Therapy in these patients regardless of age and sexual orientation. In addition, MSM subjects were two times more prone than MSW subjects to develop depression symptoms. White or mixed race men showed 7.6 times greater adherence to treatment than black men. The probability of complete adherence to treatment was 3.8 times higher in non-depressed subjects than in depressed subjects regardless of their ethnicity. The chance of developing depression was 4.17 times higher for an individual with non-adherent behavior than for an adherent individual. CONCLUSIONS: Individuals with low adherence rates have proportionally higher depression rates. Depressed men tend to show less adherence to treatment. Black but not mixed race or white men show less adherence to Highly Active Antiretroviral Therapy and have a greater chance of developing depression, which directly interferes with adherence. The chances of developing depression are four times greater for a patient with non-adherent behavior than for a patient with adherent behavior.

Quality of life, anxiety and depression in patients with HIV/AIDS who present poor adherence to antiretroviral therapy: a cross-sectional study in Salvador, Brazil

Abstract The introduction of highly active antiretroviral therapy marked a major gain in efficacy of HIV/AIDS treatment and a reduction in morbidity and mortality of the infected patients. However, high levels of adherence are required to obtain virologic suppression. In Brazil, the policy of free and universal access to antiretroviral therapy has been in place since 1996, although there are reports of poor adherence. Objective To define the clinical, demographic and psychological characteristics, and quality of life of patients with HIV/AIDS who present poor adherence to highly active antiretroviral therapy. Methods This was a cross-sectional study. To be included in the study patients had to be 18 through 65 years old, diagnosed with HIV/AIDS, having the two previous viral loads above 500 copies, a surrogate for poor adherence to antiretrovirals. The following instruments were applied to all eligible patients: the sociodemographic questionnaire "Adherence Follow-up Questionnaire", the Beck Depression Inventory (BDI-II), the Beck Anxiety Inventory (BAI), and the 36-Item Short Form Survey. Results 47 patients were evaluated, 70.2% were female, mean age of 41.9 years (±10.5), 46.8% were single, 51.1% self-reported adherence ≥95%, 46.8% mentioned depression as the main reason for not taking the medication, 59.5% presented symptoms of moderate to severe depression, and 44.7% presented symptoms of moderate to severe anxiety. Finally, regarding health-related quality of life these patients obtained low scores in all dimensions, physical component summary of 43.96 (±9.64) and mental component summary of 33.19 (±13.35). Conclusion The psychological component is considered to be fundamental in the management of HIV/AIDS patients. Psychoeducation should be conducted at the initial evaluation to reduce negative beliefs regarding antiretroviral therapy Assessment of anxiety and depression symptoms should be done throughout therapy as both psycological conditions are associated with patient adherence, success of treatment, and ultimately with patients' quality of life.

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. .

La mala calidad de sueño se asocia a una menor adherencia al tratamiento antirretroviral de gran actividad en pacientes peruanos con infección por VIH/SIDA / Poor quality of sleep associated with low adherence to highly active antiretroviral therapy in Peruvian patients with HIV/AIDS / A má qualidade do sono associada à menor aderência à terapia antirretroviral de alta atividade em pacientes peruanos com infecção pelo HIV/AIDS

Con el objetivo de evaluar si existe asociación entre la mala calidad de sueño y la adherencia al tratamiento antirretroviral de gran actividad (TARGA) en personas con infección por VIH/ SIDA; llevamos a cabo un estudio analítico de corte transversal que incluyó 389 pacientes peruanos en TARGA. La mala calidad de sueño fue medida con la Escala de Calidad de Sueño de Pittsburgh y la adherencia con el CEAT-VIH. Realizamos un modelo lineal generalizado de familia Poisson, con errores estándar robustos para estimar razones de prevalencia y su IC95%. A nivel crudo la mala calidad de sueño leve, moderada y severa se asoció a la adherencia inadecuada. Al ajustar por las variables asociadas en el análisis bivariado o por las variables teóricamente asociadas a la adherencia, sólo la mala calidad de sueño moderada/severa se mantuvo asociada (RP = 1,34; IC95%: 1,17-1,54 y RP = 1,34; IC95%: 1,16-1,57; respectivamente). Se concluye que la mala calidad de sueño moderada/severa se asocia de manera independiente con la adherencia al TARGA. La evaluación de la calidad de sueño podría por ende ser útil en la valoración integral de los pacientes con VIH.

This cross-sectional study analyzed the association between poor quality of sleep and adherence to highly active antiretroviral therapy (HAART) in 389 Peruvian patients with HIV/AIDS. Poor quality of sleep was measured with the Pittsburgh Sleep Quality Index (PSQI) and adherence with the CEAT-VIH (Peruvian adaptation). A Poisson generalized linear model with robust standard errors was used to estimate prevalence ratios and 95%CI. A crude model showed that mild, moderate, and severe poor quality of sleep were associated with inadequate treatment adherence. In the adjusted model for variables associated in the bivariate analysis or variables theoretically associated with adherence, only moderate/severe poor quality of sleep remained associated (PR = 1.34, 95%CI: 1.17-1.54; and PR = 1.34, 95%CI: 1.16-1.57, respectively). The study concluded that moderate/severe poor quality of sleep was independently associated with adherence to HAART. Assessing quality of sleep may be helpful in the comprehensive evaluation of HIV patients.

A fim de avaliar se a associação entre a má qualidade do sono e adesão à terapia antirretroviral (TARV) em pessoas com infecção pelo HIV/AIDS, realizamos um estudo analítico de corte transversal que incluiu 389 pacientes peruanos em TARV. A má qualidade do sono foi medida com a escala Índice de Qualidade de Sono de Pittsburgh (IQSP) e a aderência com o CEAT- (adaptação peruana). Foi realizado um modelo linear generalizado da família Poisson com padrão de erros robustos, para estimar as razões de prevalência e IC95%. No nível cru, a má qualidade do sono leve, moderada e grave foram associadas com adesão inadequada. Quando fizemos o ajuste para as variáveis associadas na análise bivariada ou variáveis teoricamente associadas à adesão, somente a má qualidade moderada/grave manteve-se associada (RP = 1,34; IC95%: 1,17-1,54 e RP = 1,34; IC95%: 1,16-1,57; respectivamente). Concluímos que a má qualidade do sono moderada/grave está independentemente associada com a adesão a TARV. Avaliar a qualidade do sono pode ser útil na avaliação global do paciente com HIV.

Factores psicosociales asociados con el inicio tardío de tratamiento antirretroviral en pacientes mexicanos con VIH / Psychosocial factors associated with late HAART initiation in Mexican patients with HIV

Objetivo. Explorar la asociación entre variables psicosociales y el inicio tardío de tratamiento antirretroviral en una muestra de pacientes mexicanos con diagnóstico de VIH. Material y métodos. Estudio transversal en la clínica de VIH del Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, donde se aplicaron cuestionarios estructurados a 150 pacientes que iniciaron terapia antirretroviral altamente activa (TARAA) entre enero de 2010 y agosto de 2011. Se consideró inicio tardío (IT) de TARAA cuando los pacientes iniciaron el tratamiento con CD4 <200 células/mm³. Resultados. Mediante el análisis multivariado, se encontró que el principal factor psicosocial asociado con IT fue la percepción de autoestigma relacionada con el VIH/sida. Además, la realización de la prueba del VIH se asoció con la indicación médica y no con la iniciativa del paciente; a su vez, tener uno o más contactos médicos previos se relacionó con un mayor riesgo de presentar IT. Conclusiones. Los resultados sugieren la necesidad de intervenciones psicosociales dirigidas a disminuir la autoimagen negativa y actitudes y comportamientos estigmatizantes en grupos de riesgo.

Objective. To explore the association between psychosocial factors and late highly active antiretroviral therapy (HAART) initiation in a sample of Mexican patients with HIV. Materials and methods. We conducted a cross-sectional study at the HIV Clinic of the Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán (INCMNSZ), and applied structured questionnaires to 150 patients who initiated HAART between January 2010 and August 2011. Late HAART initiation (LHI) was considered when patients started HAART with CD4 counts of <200+ cells/mm³. Results. By multivariate analysis, the strongest psychosocial risk factor for LHI observed was self-stigma towards HIV/AIDS. In addition, being tested by medical prescription, not by own initiative, as well as having one or more previous medical contacts, were associated with greater risk for LH. Conclusions. Our findings suggest the need to develop psychosocial interventions to decrease negative self-image and stigmatizing attitudes and behaviors in risk groups for HIV in Mexico.

Saúde mental, suporte familiar e adesão ao tratamento: associações no contexto HIV/Aids / Mental health, family support and treatment adherence: associations in the context of HIV/AIDS / Salud mental, soporte familiar y adhesión al tratamiento: asociaciones en el contexto VIH/Sida

A adesão dos pacientes ao tratamento antirretroviral tem sido um dos maiores desafios no contexto HIV/Aids. São muitos os fatores implicados, e este estudo buscou privilegiar os relativos à saúde mental e suporte familiar, investigando sua associação com a adesão. Para tanto, foram utilizados um questionário semiestruturado composto de informações sociodemográficas, clínicas e adesão, e os instrumentos Questionário de Saúde Geral de Goldberg (QSG) e Inventário de Percepção de Suporte Familiar (IPSF). A amostra foi composta por 73 pacientes com HIV/Aids, com idades entre 29 e 67 anos, em tratamento antirretroviral em um ambulatório de São Paulo. Os resultados apontaram índices significativos de adesão irregular aos antirretrovirais e de perfis sintomáticos para transtornos mentais nessa população. Foram encontradas correlações significativas entre adesão e o fator "desejo de morte" do QSG, e entre adesão e quase todos os fatores do IPSF, evidenciando a importância desses fatores na adesão ao tratamento...

The patient's adherence to the antiretroviral drug therapy has been one of the biggest challenges in the HIV/Aids context. Among the many implicated factors, this study sought to study the factors related to mental disorders and family support, investigating their association with the adhesion. For that matter, a semi-structured questionnaire composed by social-demographic, clinical and adherence information was applied. The Goldberg General Health Questionnaire (GHQ) and the Perceived Family Support Inventory (PFSI) were also used. The sample was composed by73 HIV/Aids patients in antiretroviral therapy, aged between 29 and 67 years old on health service in São Paulo. The results point at significant indicators of irregular adherence to the antiretroviral therapy and of symptomatic profiles of mental disorders in this population. A considerable correlation between adherence and the "death wish" factor of GHQ were found, and also between adherence and almost all the PFSI factors, demonstrating the importance of these factors in therapy adherence...

La adhesión de los pacientes al tratamiento antirretroviral es uno de los mayores desafíos en el contexto VIH/Sida. En este estudio han sido privilegiados e investigados los factores relativos a la salud mental y soporte familiar. Para esto, se aplicó un cuestionario semiestructurado compuesto por informaciones sociodemográficas, clínicas y de adhesión, y los instrumentos Cuestionario de Salud General de Goldberg (QSG) e Inventario de Percepción de Soporte Familiar (IPSF). La muestra estuvo compuesta por 73 pacientes con VIH/Sida, entre 29 y 67 años, en tratamiento antirretroviral en un ambulatorio de São Paulo. Los resultados mostraron indicios significativos de adhesión irregular a los antirretrovirales y de perfiles sintomáticos para trastornos mentales en esta población. Se encontraron correlaciones significativas entre adhesión y el factor "deseo de muerte" del QSG, y entre adhesión y prácticamente todos los factores del IPSF, mostrando la importancia de estos factores en la adhesión al tratamiento...

Depresión y adhesión a terapia anti-retroviral en pacientes con infección por VIH atendidos en el Hospital San Pablo de Coquimbo, Chile / Depression and HAART adherence in HIV infected patients attending Hospital San Pablo of Coquimbo, Chile

Despite the good HAART coverage of HIV infected patients in Chile, treatment success is interfered by patient-adherence problems. Moreover, HIV and depression co-morbidity has been shown to impair self-care and medication adherence. With the aim to analyze adherence problems and its relationship with depression in HIV infected patients, we evaluated 119 HIV infected patients, attending Coquimbo's Hospital. Our sample was incidental and transversally evaluated with: Morisky, Green & Levine Medication Adherence Scale, and the Beck - II Depression Inventory. In addition, demographic and health data were obtained from clinical files. Main results showed that 68% patients referred having HAART adherence problems, with differences in sex, age and treatment duration. Logistic regression analysis showed that patients with moderate-severe depressive symptoms have 3,08 (95% IC 1,08-8,80) times higher risk of having adherence problems compared to patients with mild to no depressive symptoms.

A pesar de la cobertura de TARV en pacientes infectados con VIH lograda en Chile, el éxito de los tratamientos se encuentra interferido por problemas de adhesión de los pacientes. Además, la co-morbilidad entre infección por VIH y depresión ha mostrado empeorar la adhesión y el automanejo de las enfermedades crónicas en general. Con el objetivo de analizar los problemas de adhesión a TARV y su relación con la depresión en pacientes infectados con VIH, se evaluó a 119 pacientes atendidos en el Programa VIH/SIDA del Hospital de Coquimbo. La muestra fue incidental y fueron aplicados en forma transversal: la Escala de Adhesión a los Medicamentos de Morisky, Green y Levine, y el Inventario de Depresión de Beck-II. Además se obtuvieron datos demográficos y de salud de las fichas clínicas. Los principales resultados muestran que 68% de los pacientes manifiesta tener problemas de adhesión a TARV, con diferencias significativas por sexo, edad y tiempo de tratamiento. Según un análisis de regresión logística, los pacientes con depresión moderada a severa tendrían 3,08 (95% IC 1,08-8,80) veces más riesgo de tener problemas de adhesión en relación a los pacientes con depresión mínima o leve.

Psychopathology and psychosocial adjustment in patients with HIV-associated lipodystrophy

OBJECTIVE: To study whether patients with HIV-1 associated lipodystrophy (LD) on highly active antiretroviral treatment (HAART) have more psychopathology and worse psychosocial adjustment than a similar group without this syndrome. METHODS: In a cross-sectional, observational study we compared 47 HIV-1 infected patients with LD (LD group) with 39 HIV-1 infected patients without LD (non-LD group). All participants were on HAART. The Beck Depression Inventory (BDI), the State and Trait Anxiety Inventory (STAI) and the Goldberg Health Questionnaire (GHQ-60) were administered. Levels of familial, work and social adjustment and adjustment to stressful events were evaluated in a semi-structured interview. Clinical information was extracted from the clinical records. RESULTS: In the univariate analysis patients with LD showed higher state anxiety scores (p = 0.009) and worse work adjustment (p = 0.019) than those without LD. A total of 45.3% of LD patients scored above the cut-off point on the trait anxiety scale, and over 33.3% scored above the cut-off point on the BDI, GHQ and state anxiety scales. However, in multivariate analyses LD was not independently associated with psychopathology or with worse adjustment in the studied areas. CONCLUSIONS: The finding that LD was not a predictor of greater psychopathology or worse psychosocial adjustment in HIV-1 infected patients, despite the high scores found, suggests that factors not taken into account in this study, such as LD severity and self-perception should have been included in the analysis. Further studies including a greater number of variables and a larger sample size will advance our understanding of this complex condition.

Análise estrutural das representações sociais da terapia antirretroviral entre pessoas que vivem com HIV/Aids: possibilidades de convivência, normatividade e ressignificação / Structural analysis of social representations of antiretroviral therapy among people living with HIV/AIDS: possibilities of coexistence, normativity and ressignification

OBJETIVOS: identificar e analisar os conteúdos e a estrutura das representações sociais da terapia antirretroviral entre pessoas que vivem com o vírus da imunodeficiência humana. MÉTODO: estudo descritivo e qualitativo. Os sujeitos foram 84 pessoas soropositivas acompanhadas em centro especializado de município norte-fluminense, Brasil. Empregou-se a técnica de evocação livre de palavras ao termo indutor terapia antirretroviral, com análise pelo quadro de quatro casas e software EVOC. RESULTADOS: identificou-se como prováveis elementos do núcleo central da representação ter vida, tem que tomar e horário certo. Observou-se subgrupo com representação mais positiva permeada pelos conteúdos de compromisso, esperança e perspectiva de viver melhor. A periferia revelou facetas positivas e negativas quanto aos conteúdos, refletindo a complexidade da representação em questão. CONCLUSÃO: a representação em estudo mostrou-se predominantemente funcional, constituindo-se como subsídio para intervenções profissionais em saúde e enfermagem na promoção da adesão terapêutica e qualidade de vida de pessoas soropositivas.

OBJECTIVES: to identify and analyze the content and structure of social representations of antiretroviral therapy among people living with the human immunodeficiency virus. METHOD: descriptive and qualitative study. The subjects were 84 HIV positive people in follow-up in specialized center municipality North Fluminense, Brazil. We applied the technique of free recall of words to the inductive term antiretroviral therapy, with analysis using four-frame houses and software EVOC. RESULTS: identified as probable core elements of representation to have life, tp have take and exact time. Observed subgroup with more positive representation permeated the contents of commitment, hope and prospect of a better life. The periphery showed positive and negative facets as to content, reflecting the complexity of the representation in question. CONCLUSION: The study showed representation is predominantly functional, constituting as a basis for interventions in health and nursing professionals in promoting adherence and quality of life of people living with HIV.

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.

Depressive symptoms in HIV-infected patients treated with highly active antiretroviral therapy / Sintomas depressivos em pacientes infectados pelo HIV tratados por terapia antiretroviral altamente ativa

INTRODUCTION: The prevalence of depressive disorders in HIV-infected patients ranges from 12% to 66% and is undiagnosed in 50% to 60% of these patients. Depression in HIV-infected individuals may be associated with poor antiretroviral treatment (ART) outcomes, since it may direct influence compliance. OBJECTIVE: To assess the presence of symptoms and risk factors for depression in patients on ART. METHODS: Cross-sectional study. Certified interviewers administered questionnaires and the Beck Depression Inventory (BDI), and participants' self-reported compliance to ART. Clinical and laboratory variables were obtained from clinical records. Patients with BDI > 12 were defined as depressed. RESULTS Out of the 250 patients invited to participate, 246 (98%) consented. Mean age was 41 ± 9.9 years; most were male (63%). Income ranged from 0-14 Brazilian minimum wages. AIDS (CDC stage C) had been diagnosed in 97%, and 81% were in stable immune status. One hundred ninety-one (78%) reported compliance, and 161 (68%) had undetectable viral loads. The prevalence of depressive symptoms was 32% (95% CI 26-40). In multivariate analysis, depressive symptoms were significantly associated with income (prevalence ratio [PR] = 0.85; 95% CI 0.74-0.97; p = 0.02). CONCLUSIONS: Depressive symptoms are frequent in patients on ART, and are associated with low income.

INTRODUÇÃO:A prevalência de transtornos depressivos em pacientes infectados pelo HIV varia de 12% a 66% e não é diagnosticada em 50% a 60% desses pacientes. A depressão em indivíduos HIV positivo pode se associar a resultados fracos do tratamento antirretroviral (TAR) porque pode influenciar diretamente a aderência ao regime. OBJETIVO: Avaliar a presença de sintomas e de fatores de risco de depressão em pacientes em TAR. MÉTODOS: Estudo em corte transverso. Entrevistadores certificados administraram questionários e o Beck Depression Inventory (BDI), e os participantes fizeram o autorrelato da aderência ao TAR. Variáveis clínicas e laboratoriais foram obtidas dos prontuários clínicos. Os pacientes com escore ao BDI > 12 foram definidos como deprimidos. RESULTADOS: Dos 250 pacientes convidados a participar, 246 (98%) concordaram. A média de idade foi de 41 ± 9,9 anos; a maioria dos pacientes era do sexo masculino (63%). A renda variou de 0-14 salários mínimos brasileiros. A AIDS (estágio C dos CDC) havia sido diagnosticada em 97% e 81% estavam em estado imune estável. Dos pacientes, 191 (78%) relataram aderência e 161 (68%) tinham carga viral não detectável. A prevalência dos sintomas depressivos foi de 32% (IC 95% 26-40). Em análise multivariada, os sintomas depressivos se associaram significativamente à renda (razão de prevalência [RP] = 0,85, IC 95% 0,74-0,97; p = 0,02). CONCLUSÕES: Os sintomas depressivos são frequentes em pacientes em TAR e se associam a uma renda baixa.

Sida y salud mental: recomendaciones / Aids and mental health: psychologist's role in the adherence in the XXI century

En los últimos años se han producido grandes avances en el campo de la terapia antirretroviral. La consecuencia ha sido una reducción en la progresión de la enfermedad, una mejoría en la calidad de vida de los pacientes y una disminución del número de infecciones oportunistas, así como de internaciones de los pacientes con VIH. Es fundamental e imprescindible para el abordaje integral de esta patología que el psicólogo esté dispuesto a revisar el posicionamiento clásico y ortodoxo en la atención clínica. El psicólogo deberá conocer sobre aspectos médicos, indicaciones y contraindicaciones de los antirretrovirales, frecuencia en la realización de carga viral y CD4, etc. En este trabajo se definen instancias de intervención en la adherencia como ser: a) Preparación para inicio de tratamiento antirretroviral (TARV) b) Asesoramiento y Orientación para sostenimiento de la adherencia c) Asesoramiento y Orientación para reinicio de TARV. Para finalizar se describe la implementación de lo que hemos denominado como "Kit de adherencia" y se concluye que es imprescindible que el psicólogo intervenga ofertando al paciente el siguiente dispositivo asistencial: Psicoterapia individual, Grupo de apoyo en adherencia, Grupo de apoyo para familiares y allegados, Grupo de apoyo para miembros negativos de parejas serodiscordantes.

AIDS and Mental Health. Psychologist's role in the adherence in the XXI century . In recent years there have been major advances in the field of antiretroviral therapy. The result has been a reduction in disease progression, improved quality of life of patients and a decreased number of opportunistic infections and hospitalizations of patients with HIV. Is fundamental and essential to the comprehensive approach of this desease that the psychologist is willing to revise the classic orthodox position of clinical care. The psychologist should know about medical aspects, indications and contraindications of antiretroviral drugs, often in the implementation of viral load and CD4, etc. In this paper we define instances of intervention in the bond such as: a) Preparing to start antiretroviral therapy (ART) b) advice and guidance to support adherence c) Advice and Guidance for restarting ART. The final section describes the implementation of what we called "Adherence's Kit" and concludes that it is imperative that the psychologist involved offering the following device patient care: Individual, group adherence support, support group for family and relatives, support group members serodiscordant negative.

Estrategias de afrontamiento y ansiedad-depresión en pacientes diagnosticados con VIH/Sida / Copying strategies, anxiety and depression in HIV/Aids patients

El objetivo de este estudio fue evaluar las estrategias afrontamiento y la ansiedad-depresión en 92 pacientes de ambos géneros diagnosticados con VIH/Sida en tratamiento antirretroviral de la ciudad de Medellín, Colombia. La investigación tuvo como diseño un estudio descriptivo transversal correlacional mediante encuesta. Para medir las estrategias de afrontamiento se utilizó la Escala de Estrategias de Coping Modificada (EEC-M) de 98 ítems y la ansiedad-depresión se midió a través de los cuestionarios de Zung (SAS y SDS). Los resultados evidenciaron muy bajos niveles de ansiedad y depresión y alto uso de estrategias de afrontamiento de tipo cognitivo (focalizadas en el problema), de búsqueda de apoyo en la religión y profesionales de la salud, alto empleo de la estrategia de control emocional y muy bajo uso de la estrategia de reacción agresiva. En conclusión, las estrategias focalizadas en la cognición como búsqueda de alternativas, refrenar afrontamiento, reevaluación positiva e incluso la religión y búsqueda de apoyo profesional que son fundamentales para encontrar soluciones a nivel cognitivo ante los síntomas físicos y reacciones emociones tuvieron más relevancia en los pacientes con VIH/Sida.

The aim of this study was to evaluate the copying strategies and depression-anxiety in 92 patients of both genders with a diagnosis of fu V/Aids from the city of Medellín, Colombia. The investigation was a descriptive transversal co relational study. To measure copying strategies the Copying Strategies Scale Modified (CSS-M) was used of 98 items and anxiety-depression was measured through the questionnaires of Zung (SAS y SDS). The results evidenced very low levels of anxiety and depression and high use of copying strategies of cognitive type (focalized in the problem), of support search in religion and health professionals, high employment of emotional control strategies and very low use of the strategy of aggressive reaction. In conclusion, the strategies focalized in the cognition like search of alternative (problem solving), to refrain copying, positive reevaluation and even the religion and search of support professional that are fundamental to find solutions at the cognitive level before the physical symptoms and emotional reactions had more relevance in the patients with HTV/Aids.

VIH-sida y parejas serodiscordantes: aproximaciones a los miembros negativos desde la perspectiva bio-médica / HIV-AIDS and serodiscordants couples: approaches to the negative members from the biomedical perspective

El trabajo tiene por objetivo describir los resultados de una investigación cualitativa que tuvo por propósito indagar, a través de entrevistas semiestructuradas, las percepciones de los/as profesionales de salud con relación a la atención del miembro negativo de las parejas serodiscordantes. El análisis de los resultados muestra la escasez de espacios y acciones de salud destinadas específicamente a dichos sujetos y la invisibilización de los mismos en los ámbitos de atención pública de salud. Se pretende proveer conocimientos que faciliten la reflexión acerca de la problemática en cuestión y aportar a la planificación y puesta en práctica de dispositivos destinados específicamente a los miembros negativos.

The aim of this paper is to describe the results of a qualitative research which objective was to analyze the perceptions of health professional regarding to the attention of serodiscordant couples negative member. Our results show that the spaces and health actions destined to these people are almost nonexistent and that they are neglected in the public health attention field. This research also expects to stimulate social reflections about this problematic and tries to contribute to the planning and implementations of actions and devices destined to negative members.