ABSTRACT
Use of alcohol and illicit drugs is a common finding among HIV-infected individuals, but there are many open questions about its impact on adherence to antiretroviral therapy and virological outcomes. Our study aimed to evaluate the impact of the use of alcohol and illicit drugs on the adherence to antiretroviral therapy (ART) among patients starting ART in Salvador, Brazil. We followed up 144 AIDS patients initiating ART for a 6-month period. At baseline, they were interviewed about demographics, behavior, and use of illicit drugs and alcohol. All of them had HIV-1 RNA plasma viral load and CD4(+)/CD8(+) cells count measured before starting therapy. After 60 days of treatment they were asked to answer a new questionnaire on adherence to ART. All patients were monitored during the following months, and new CD4(+) cell count/HIV-1 RNA plasma viral load determinations were performed after 6 months of therapy. Optimal adherence to therapy was defined by self-reported questionnaire, by 95% use of prescribed drug doses, and by using plasma HIV-1 RNA viral load as a biological marker. A total of 61 (42.4%) patients reported alcohol use, 7 (4.9%) used illicit drugs, and 17 (11.8%) used both alcohol and illicit drugs. Being in a steady relationship was protective to nonadherence (95% CI: 0.18-0.84). Missing more than two medical visits was also associated with a 68% higher likelihood of nonadherence (95% CI: 0.10-1.02). After logistic regression we detected a higher risk of nonadherence for patients declaring use of alcohol plus illicit drugs (odds ratio=6.0; 95% CI: 1.78-20.28) or high-intensity use of alcohol (odds ratio=3.29; 95% CI: 1.83-5.92). AIDS patients using alcohol and/or illicit drugs are socially vulnerable, and need specific and flexible programs, combining mental health care, harm reduction strategies, and assisted drug therapy to maximize the chances of successful use of ART.
Subject(s)
Acquired Immunodeficiency Syndrome/drug therapy , Alcoholism/complications , Anti-HIV Agents/therapeutic use , Medication Adherence/psychology , Substance-Related Disorders/complications , Acquired Immunodeficiency Syndrome/psychology , Adult , Aged , Brazil/epidemiology , CD4-CD8 Ratio , Female , HIV-1 , Humans , Logistic Models , Male , Medication Adherence/statistics & numerical data , Middle Aged , Surveys and Questionnaires , Viral Load , Young AdultABSTRACT
The problems related to the means of transport in urban Brazilians have been getting worse over the years. The increase of the fleet, to the detriment of the adequacy and extent of the road network of cities contributes to this fact. This paper presents a profile of users of cycling in the city of Juiz de Fora, and thus contributes to the study of sustainable urban mobility, providing researchers with information that can guide the search for the encouragement of the use of means of transport to meet environmental needs urban centers that contributes to social equity.