ABSTRACT
The aim of the study is to evaluate the influence of antiretroviral treatment on health-related quality of life (HRQOL) of three groups of HIV-positive inmates: those who are taking antiretroviral treatment, those who are not on treatment as it has not yet been indicated, and those who refuse to take treatment even though it has been recommended. A cross-sectional study was conducted on 585 HIV+ inmates in three prisons. The response variable was HRQOL. Independent variables were: sociodemographic variables, psychosocial and drug-related variables. Two multivariate linear regression models were constructed in order to determine the HRQOL, physical health score (PHS) and mental health score (MHS), for each of the three groups identified, using patients who refused treatment as the reference category. Patients who refused therapy had a lower MHS compared with patients in whom treatment was not indicated (P = 0.038). With regard to PHS, patients refusing therapy had a lower score than patients who were not indicated therapy (P = 0.005), and than patients receiving therapy (P = 0.010).
Subject(s)
Anti-HIV Agents/therapeutic use , HIV Seropositivity/drug therapy , HIV Seropositivity/psychology , Prisoners , Quality of Life , Adult , Cross-Sectional Studies , Female , Humans , Male , Outcome Assessment, Health Care , Prisons , Spain , Surveys and QuestionnairesABSTRACT
INTRODUCTION: Current studies of HIV+ patients in the prison population have been carried out without considering differences that might exist between patients who accept retroviral treatment and those who do not. One possible reason for this may be the difficulty in gaining access to patients who refuse antiretroviral treatment. However, the prison environment makes it possible to locate and study this type of patient, who up till now has not been the subject of study. The aim of this article is to describe the clinical and psychosocial state of HIV+ inmates who refuse ARVT and compare this data with patients receiving treatment and others for whom treatment has not been indicated. METHODS: Cross-sectional study using 585 HIV+ inmates in three prisons in Andalusia from May to June 2004. Refusal, acceptance and non-indication of ARVT treatment was the grouping variable used. The independent variables were socio-demographic, psychosocial, clinical and other variables relating to the prison environment. RESULTS: 16.8% of patients refused ARVT, while 56.3% were receiving treatment and another 26.8 were not indicated for any medication. Amongst the patients that refused ARVT there was a greater prevalence of HIV co-infection, higher inprison consumption of opiates and methadone treatment, more cases pending and higher rates of recidivism. CONCLUSIONS: these results highlight the existence of a group with unique characteristics that is accessible thanks to the special conditions within the prison environment. It is a group that chooses not to follow therapeutic indications and which represents a risk factor not only for its own health, but also for the community at large.
ABSTRACT
Introducción: En los estudios existentes sobre pacientes VIH+ la población a estudio ha sido tomada de manera homogénea,sin diferenciar aquella que cumple los requerimientos terapéuticos de la que no lo hace. Quizás por la dificultad en elacceso al grupo de pacientes que rehúsan el tratamiento antirretroviral. El medio penitenciario nos permite acceder a esta población,hasta hoy no estudiada. El objetivo de este estudio es describir el estado clínico y psicosocial de los reclusos seropositivosque rehúsan el TARV, comparándolo con el de aquellos que sí están en TARV o no se les indica tomarlo.Métodos: Estudio transversal con 585 reclusos VIH positivos ingresados en tres prisiones andaluzas entre mayo-juliode 2004. Como variable de agrupación se empleó rehusar el TARV, tomarlo o no hacerlo por no estar indicado. Como independientesse incluyeron sociodemográficas, psicosociales, clínicas y relacionadas con el medio penitenciario.Resultados: El 16,8% de los reclusos rehusaban el TARV, mientras el 56,3% estaban en tratamiento y al 26,8% no le estabaindicado. Entre los reclusos que rehusaban el TARV aparece una mayor prevalencia de coinfección por VHC, mayorconsumo intrapenitenciario de opiáceos y tratamiento con metadona, más juicios pendientes y más entradas en prisión.Conclusiones: Estos resultados ponen de relieve la existencia de un grupo poblacional, accesible gracias al medio penitenciario,con características propias que no sigue las indicaciones terapéuticas y que representa un riesgo no sólo para su salud, sino para la de la comunidad (AU)
Introduction: Current studies of HIV+ patients in the prison population have been carried out without considering differencesthat might exist between patients who accept retroviral treatment and those who do not. One possible reason forthis may be the difficulty in gaining access to patients who refuse antiretroviral treatment. However, the prison environmentmakes it possible to locate and study this type of patient, who up till now has not been the subject of study. The aim of thisarticle is to describe the clinical and psychosocial state of HIV+ inmates who refuse ARVT and compare this data with patientsreceiving treatment and others for whom treatment has not been indicated.Methods: Cross-sectional study using 585 HIV+ inmates in three prisons in Andalusia from May to June 2004. Refusal,acceptance and non-indication of ARVT treatment was the grouping variable used. The independent variables were socio-demographic, psychosocial, clinical and other variables relating to the prison environment.Results: 16.8% of patients refused ARVT, while 56.3% were receiving treatment and another 26.8 were not indicated (AU)
Subject(s)
Humans , Male , Female , Patient Dropouts/statistics & numerical data , HIV Infections/drug therapy , Anti-HIV Agents/therapeutic use , Prisoners/statistics & numerical data , Cross-Sectional Studies , SpainABSTRACT
INTRODUCTION: Among HIV positive patients the CD4 lymphocyte count, especially the viral load, are the best predictors for progress to full blown AIDS or death. OBJECTIVE: To analyze the factors associated with progress of the CD4 lymphocyte count and viral load in prison inmates in antiretroviral treatment. METHODS: A fixed cohort study was conducted with HIV positive inmates receiving antiretroviral therapy in three Spanish prisons. Adherence to antiretroviral treatment was assessed with the SMAQ questionnaire. To analyze the progress of CD4 and viral load clinical parameters, two fixed effect multilevel linear regression models were utilised. RESULTS: 10% of the sample were women, 42% referred for anxiety or symptoms of depression in the final week, and 46.6% reported having social support inside the prison. CD4 and viral load clinical parameter means were 2.48 and 2.89 respectively, and 38.6% had an undetectable viral load. A negative correlation between viral load and CD4 lymphocyte count (p<0.001) was found. Those inmates who did not present psychological morbidity showed a significant reduction in plasma viral load (p=0.017). CONCLUSIONS: The results of this study show the relevance of psychosocial factors in the immune system.
ABSTRACT
Introducción: Entre los pacientes infectados por el VIH el recuento linfocitario y fundamentalmente la carga viral, sonlos mejores predictores al estado definitorio de SIDA o muerte. Objetivo: analizar los factores asociados a la evolución delrecuento de linfocitos CD4 y carga viral en reclusos en tratamiento con antirretrovirales. Métodos: Se realizó un estudio decohorte fija a reclusos VIH positivos en tratamiento con antirretrovirales de tres prisiones españolas. La adherencia al tratamientoantirretroviral se midió a través del cuestionario SMAQ. Para analizar la evolución de los parámetros clínicos de CD4y carga viral se realizaron dos modelos de regresión lineal multinivel de efectos fijos. Resultados: El 10% eran mujeres, el42% refirió padecer ansiedad o depresión en la última semana y el 46,6% refirió tener apoyo social dentro de la prisión. Encuanto a la media de los parámetros clínicos de log10 CD4 y log10 carga viral fueron de 2,48 y 2,89 respectivamente, teniendoel 38,6% carga viral indetectable. Se encontró una relación inversa entre la carga viral y el recuento de linfocitos CD4(p<0,001). En cuanto a la carga viral plasmática aquellos reclusos sin morbilidad psíquica mostraron una reducción significativa (p=0,017) de la misma. Conclusiones: se pone de manifiesto la importancia de los factores psicosociales en el sistema inmunitario (AU)
Introduction: Among HIV positive patients the CD4 lymphocyte count, especially the viral load, are the best predictorsfor progress to full blown AIDS or death. Objective: To analyze the factors associated with progress of the CD4lymphocyte count and viral load in prison inmates in antiretroviral treatment. Methods: A fixed cohort study was conductedwith HIV positive inmates receiving antiretroviral therapy in three Spanish prisons. Adherence to antiretroviral treatmentwas assessed with the SMAQ questionnaire. To analyze the progress of CD4 and viral load clinical parameters, two fixedeffect multilevel linear regression models were utilised. Results: 10% of the sample were women, 42% referred for anxietyor symptoms of depression in the final week, and 46.6% reported having social support inside the prison. CD4 andviral load clinical parameter means were 2.48 and 2.89 respectively, and 38.6% had an undetectable viral load. A negative correlationbetween viral load and CD4 lymphocyte count (p<0.001) was found. Those inmates who did not present psychologicalmorbidity showed a significant reduction in plasma viral load (p=0.017). Conclusions: The results of this study showthe relevance of psychosocial factors in the immune system (AU)
Subject(s)
Humans , Anti-Retroviral Agents/therapeutic use , HIV Infections/drug therapy , Antiretroviral Therapy, Highly Active , Viral Load , CD4 Antigens/isolation & purification , Anti-HIV Agents/therapeutic useABSTRACT
The pathology related with the altitude is a common entity above 3000 m. It includes mild symptoms to severe illness such as cerebral or pulmonary edema. Cold-induced injuries may produce permanent tissue loss and surgical amputation. Recognition is made mainly through symptoms. Adequate treatment of these patients allows for rapid resolution of the symptoms and improves outcome.
Subject(s)
Altitude Sickness/etiology , Altitude , Dehydration/etiology , Frostbite/etiology , Hypothermia/etiology , Mountaineering , Altitude Sickness/blood , Altitude Sickness/therapy , Amputation, Surgical , China , Combined Modality Therapy , Dehydration/therapy , Fluid Therapy , Frostbite/surgery , Frostbite/therapy , Humans , Hypothermia/therapy , Hypoxia/blood , Hypoxia/etiology , Hypoxia/therapy , Male , Middle Aged , Oxygen/blood , Oxygen Inhalation Therapy , Pakistan , Rewarming , Severity of Illness Index , Toes/surgeryABSTRACT
Quality of life (QoL) is one of the most commonly used self-assessment outcome measures in chronic disease. The prison environment has specific characteristics that may affect antiretroviral treatment and adherence in HIV-positive patients. The objective of this cross-sectional study was to analyse the association between several factors and QoL in inmates on antiretroviral treatment in three Andalusian prisons. A total of 160 patients on antiretroviral treatment was enrolled. QoL was measured by means of the MOS-HIV. Of the sample, 88% were men and, of these, 53.8% were considered adherent to treatment. In the multivariate analysis, inmates who were considered adherent, who had a higher educational level, who did not receive food supplements and who were prescribed a greater number of pills were found to have a better physical and mental QoL. Likewise, those who felt unable or scarcely able to continue the treatment and who had been drug abusers for a longer time presented a lower physical QoL. Regarding mental QoL, those without a fixed abode, with difficulties in treatment or chronic disease had lower scores.
Subject(s)
Antiretroviral Therapy, Highly Active , HIV Infections/drug therapy , Quality of Life , Adult , Cross-Sectional Studies , Female , HIV Infections/psychology , Humans , Male , Prisons , SpainABSTRACT
La patología relacionada con la altura es un trastorno frecuente por encima de los 3.000 metros de altitud. Puede comprender desde síntomas leves hasta cuadros graves como el edema cerebral o pulmonar relacionado con la altitud. Las lesiones locales en forma de congelaciones de distinta profundidad pueden producir pérdidas importantes de tejido y amputaciones. El diagnóstico es eminentemente clínico y el tratamiento adecuado de estos pacientes permite una rápida resolución de la sintomatología y evita el desarrollo de secuelas posteriores
The pathology related with the altitude is a common entity above 3000 m. It includes mild symptoms to severe illness such as cerebral or pulmonary edema. Cold-induced injuries may produce permanent tissue loss and surgical amputation. Recognition is made mainly through symptoms. Adequate treatment of these patients allows for rapid resolution of the symptoms and improves outcome
Subject(s)
Male , Middle Aged , Humans , Altitude Sickness/diagnosis , Altitude Sickness/therapy , Pulmonary Edema/etiology , Hypothermia/etiology , Frostbite/etiology , Brain Edema/etiologyABSTRACT
OBJECTIVE: To define the incidence of depressive disorders and anxiety disorders in prisoners of three prisons of CCAA in treatment with antiretrovirals, and moreover the associated variables and the intensity of social support within the prison. METHODS: Through a cross-sectional design 281 prisoners were studied. RESULTS: 42% showed mental morbidity and 53.4% lacked social support. To be imprisoned in the Granada prison, to be a woman, poor health state, to describe difficulties for compliance with antiretrovirals drug, a history greater than 13 years for drugs consumption, and usual residence with the couple of family, all were factors associated with mental morbidity. Factors associated with social support non-existence were history of more than one imprisonment, lack of familiarity with the medical equipment, to be more than 35 years old, and to suffer mental morbidity.
