Estudo sobre o perfil de adesão e retirada de medicamentos da terapia antirretroviral em pessoas vivendo com HIV/AIDS

Abstract

Adherence to combination antiretroviral therapy (cART) remains a major challenge in the treatment of HIV (Human Immunodeficiency Virus). People infected with the virus have free access to therapy in Brazil. However, for it to be effective, it is necessary that the patient conducts the prolonged maintenance of the treatment, as the effectiveness of cART depends directly on the patient's compliance. The aim of this study was to characterize the epidemiological profile, perform the diagnosis of adherence to cART, as well as to outline the profile of adherence indicators in patients registered at the Specialized Service for HIV/AIDS (SAE) in the municipality of Uruguaiana/RS. A research was carried out with a historical cohort design based on secondary data for a period of 24 months, based on the SICLOM (Logistic Control System of Medicines) and SISCEL (Control System for Laboratory Examinations of the National Network of CD4 +/CD8 + Lymphocyte Count and HIV Viral Load) database. Among the patients registered in the SAE, 643 were able to participate in the study based on the established inclusion criteria. Women were the majority in this population (50.2%) with an average age of 42 years. Adherence was verified through the frequency of withdrawal of cART in the period of 24 months, being found that in 12.4% of the patients there was 100% of adherence, while in 24.3% of the patients they were not adherent to cART. The median number of days in arrears to fetch medication was 10.8 days with an interquartile interval of 13.54. The number of delays in cART withdrawal among patients was 5.6 ± 3.4 times. A positive estimate was attributed to the value calculated for the adherence indicators (0.83) and also for the delay in days and for how many times the patient was late to reset the treatment during the 24-month follow-up of the cohort (0.09 and 0.21 respectively). Significant statistical values (p0.01) and weak correlations (<0.4) were found in the relationship between adherence and days of delay to reset the cART (Spearman's rho = -0.349 and 0.198 respectively). The final model of multivariate linear regression to identify the predictive factors for the outcomes of adherence and delay (p0.01) was age between 20 and 59 years, male, not having changed the cART and an increase of one thousand copies/mL of the HIV virus in the blood of patients, which contributes negatively to the success of the therapy, putting it at risk. In this study, we can demonstrate that it is possible to assess adherence and delay in replenishing therapy by withdrawing medication monthly. In addition, providing analysis on what factors may be interfering with patients' adherence, helping them to delay to replace drug therapy, thus contributing to specific monitoring within the specialized service, filling possible gaps in the continuous care of this population.