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Fumaz CR, Muñoz-Moreno JA, Moltó J, Ferrer MJ, López-Blázquez R, Negredo E, Paredes R, Gómez G, Clotet B. Sustained antiretroviral treatment adherence in survivors of the pre-HAART era: attitudes and beliefs. AIDS Care 2008; 20:796-805. [PMID: 18728987 DOI: 10.1080/09540120701694022] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
The objective of this study was to assess adherence of HIV-1-infected patients who started treatment in the pre-HAART era and to determine variables associated with better adherence, including relevant attitudes and beliefs. This is a cross-sectional study enrolling patients who had received antiretroviral therapy for >or=10 years. Adherence was evaluated through self-reporting and plasma drug concentrations. Treatment variables, attitudes and beliefs were collected during structured interviews. The results show that for 87 patients the median (interquartile range) time on therapy was 13 (10-19) years; 80 were on therapy at the time of analysis. Adherence was >or=95% in 54 patients (67.5%), 90-94% in 22 (27.5%) and <90% in 4 (5%). Drug concentrations were below the lower limit of detection in five patients. Younger age (p=0.014), female gender (p=0.005), current substance abuse (p=0.004) and hepatitis C virus co-infection (p<0.001) were related to lower adherence. Adherence did not differ in relation to different drug families or once- or twice-daily regimens. Patients with adherence <95% were more likely to have interrupted treatment without doctor's recommendation (p=0.009). Adherent patients exhibited a higher perception of risk of developing the illness and of benefits of therapy, higher self-efficacy and intention to adhere and were more influenced by events that motivate medication intake. To conclude, adherence was >90% in most patients on antiretroviral therapy for >or=10 years. Adherence was more related to beliefs about health and illness than to the characteristics of medication or level of knowledge about treatment. Care adherence interventions should include assessment of health beliefs.
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Affiliation(s)
- C R Fumaz
- Lluita contra la SIDA Foundation, Barcelona, Spain.
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Fumaz CR, Muñoz-Moreno JA, Ballesteros AL, Paredes R, Ferrer MJ, Salas A, Fuster D, Masmitjà E, Pérez-Alvarez N, Gómez G, Tural C, Clotet B. Influence of the type of pegylated interferon on the onset of depressive and neuropsychiatric symptoms in HIV-HCV coinfected patients. AIDS Care 2007; 19:138-45. [PMID: 17129869 DOI: 10.1080/09540120600645539] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
This is a prospective observational comparative 48-week study to assess the impact of the different types of Peg-IFN on depressive and neuropsychiatric symptoms during treatment in HIV-HCV coinfected patients. Thirty-one patients treated with Peg-IFN alpha-2b 1.5 microg/kg/w plus ribavirine (RBV) (Peg-IFN alpha-2b Group) and 32 patients receiving Peg-IFN alpha-2a 180 microg/w plus RBV (Peg-IFN alpha-2a Group) were included. Depressive and neuropsychiatric symptoms, quality of life and adherence were assessed. Fifteen subjects (23%) discontinued therapy (p = 0.3, between groups). Overall, 37 patients presented mild to moderate depressive symptoms, 9 moderate to severe and 3 severe, without differences between groups. Patients in Peg-IFN alpha-2b reported higher fatigue and dizziness at weeks 12 (p < 0.05) and 24 (p < 0.05), and irritability and memory loss at week 24 (p < 0.05) with respect to Peg-IFN alpha-2a Group. At week 12, role functioning, general health perception, vitality, emotional role, mental health and the summary areas of physical health and mental health were lower in Peg-IFN alpha-2b Group (p < 0.05). The same was observed in physical functioning (p = 0.05) and role functioning, general health perception, emotional role and mental health (p < 0.001) at week 24. Three months after finishing treatment, no patient had depressive or neuropsychiatric symptoms, and quality of life improved. Antiretroviral adherence was low but adherence to anti-HCV therapy remained high in both groups. According to our data, Peg-IFN alpha-2a and Peg-IFN alpha-2b exert a similar impact on the overall rate of depressive symptoms, although patients treated with Peg-IFN alpha-2a experience less fatigue and fewer neuropsychiatric symptoms and a lower impairment in their physical and mental quality of life.
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Affiliation(s)
- C R Fumaz
- Universitat Autònoma de Barcelona, Barcelona, Spain.
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Polo R, Gómez-Candela C, Miralles C, Locutura J, Alvarez J, Barreiro F, Bellido D, Câncer E, Cánoves D, Domingo P, Estrada V, Fumaz CR, Galindo MJ, García-Benayas T, Iglesias C, Irles JA, Jiménez-Nacher I, Lozano F, Marqués I, Martínez-Alvarez JR, Mellado MJ, Miján A, Ramos JT, Riobo P. Recommendations from SPNS/GEAM/SENBA/SENPE/AEDN/SEDCA/GESIDA on nutrition in the HIV-infected patient. NUTR HOSP 2007; 22:229-43. [PMID: 17416041] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/14/2023] Open
Abstract
OBJECTIVE to make recommendations on the approach to nutritional problems (malnutrition, cachexia, micronutrient deficiency, obesity, lipodystrophy) affecting HIV-infected patients. METHODS these recommendations have been agreed upon by a group of expertes in the nutrition and care of HIV-infected patients, on behalf of the different groups involved in drafting them. Therefore, the latest advances in pathophysiology, epidemiology, and clinical care presented in studies published in medical journals or at scientific meetings were evaluated. RESULTS there is no single method of evaluating nutrition, and diferent techniques--CT, MRI, and DXA--must be combined. The energy requirements of symptomatic patients increase by 20-30%. There is no evidence to support the increase in protein or fat intake. Micronutrient supplementation in only necessary in special circumstances (vitamin A in children and pregnant woman). Aerobic and resistance excercise is beneficial both for cardiovascular health and for improving lean mass and muscular strength. It is important to follow the rules of food safety at every stage in the chain. Therapeutic intervention in anorexia and cachexia must be tailored, by combining nutritional and pharmacological support (appetite stimulants, anabolic steroids, and, in some cases, testosterone). Artificial nutrition (oral supplementation, enteral or parenteral nutrition) is safe and efficacious, and improves nutritional status and response to therapy. In children, nutritional recommendations must be made early, and are a necessary component of therapy. CONCLUSION appropriate nutritional evaluation and relevant therapeutic action are an essential part of the care of HIV-infected patients.
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Affiliation(s)
- R Polo
- Plan Nacional sobre el Sida, España
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Negredo E, Paredes R, Peraire J, Pedrol E, Côté H, Gel S, Fumaz CR, Ruiz L, Abril V, de Castro ER, Ochoa C, Martinez-Picado J, Montaner J, Rey-Joly C, Clotet B, Clotet B, Ruiz L, Martinez-Picado J, Gel S, Fumaz CR, Muñoz-Moreno JA, Bonjoch A, Martínez JC, Miranda J, Puig J, Arisa ER, Tuldrà A, Bonjoch A, Jou A, Tural C, Sirera G, Romeu J, Negredo E, Zala C, Ochoa C, Cahn P, Torres O, Domingo P, Vilaró J, Llibre JM, Peraire J, Vidal F, Richart C, Viladés C, Martín L, Rodríguez R, Mata R, Viciana P, Abril V, Rubio R, Torralba M, Cervantes M, Gatell JM, Lonca M, Ruiz I, Azuaje C, Pedrol E, Rodríguez de Castro E. Alternation of Antiretroviral Drug Regimens for HIV Infection. Efficacy, Safety and Tolerability at Week 96 of the Swatch Study. Antivir Ther 2004. [DOI: 10.1177/135965350400900602] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Introduction Alternation of antiretroviral drug regimens has been proposed as a novel treatment strategy for HIV infection. However, some concerns persist regarding antiviral efficacy, adherence, toxicity and resistance evolution in the long term. Methods A total of 161 antiretroviral-naive HIV-1-infected patients were randomized to receive stavudine/ didanosine/efavirenz (group A) or zidovudine/lamivudine/ nelfinavir (group B) or to alternate between the two regimens every 3 months starting with regimen A (group C). Antiviral efficacy, adherence, safety and tolerability were analysed every 12 weeks. Results After 96 weeks, time to virological failure was significantly delayed in the alternating regimen compared with the standards of care regimens. Virological suppression was seen in 46%, 48% and 58% of patients in groups A, B and C, respectively, in the intention-to-treat analysis and in 75%, 76% and 97% in the on-treatment analysis (A vs C: P=0.014; B vs C: P=0.016; A vs B: P=0.849). At the end of the study, 94% of patients in group A and 92% in groups B and C reported an adherence greater than 95%. Alternating therapy was associated with a similar impact on CD4+ counts in comparison with the standards of care regimens, as well as a lower mitochondrial DNA/nuclear DNA (mtDNA/nDNA) ratio decrease in the mitochondrial substudy performed on 37 patients. The frequency and intensity of adverse events in the alternating group decreased during subsequent cycles. Discussion Our results favour the hypothesis that proactive therapy switching may delay the accumulation of resistance mutations. Moreover, the alternating regimen was well tolerated and adherence remained comparably high in all treatment groups. The lower mtDNA/nDNA ratio decrease observed in this group may imply a lower impact on mitochondrial toxicity than in standard regimens.
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Affiliation(s)
| | - Eugenia Negredo
- Department of Internal Medicine and Lluita contra la SIDA and IrsiCaixa Foundations, Hospital Universitari Germans Trias i Pujol, Barcelona, Spain
| | - Roger Paredes
- Department of Internal Medicine and Lluita contra la SIDA and IrsiCaixa Foundations, Hospital Universitari Germans Trias i Pujol, Barcelona, Spain
| | | | | | - Helene Côté
- British Columbia Centre for Excellence in HIV/AIDS, Vancouver, BC, Canada
| | - Silvia Gel
- Department of Internal Medicine and Lluita contra la SIDA and IrsiCaixa Foundations, Hospital Universitari Germans Trias i Pujol, Barcelona, Spain
| | - Carmina R Fumaz
- Department of Internal Medicine and Lluita contra la SIDA and IrsiCaixa Foundations, Hospital Universitari Germans Trias i Pujol, Barcelona, Spain
| | - Lidia Ruiz
- Department of Internal Medicine and Lluita contra la SIDA and IrsiCaixa Foundations, Hospital Universitari Germans Trias i Pujol, Barcelona, Spain
| | | | | | | | - Javier Martinez-Picado
- Department of Internal Medicine and Lluita contra la SIDA and IrsiCaixa Foundations, Hospital Universitari Germans Trias i Pujol, Barcelona, Spain
| | - Julio Montaner
- British Columbia Centre for Excellence in HIV/AIDS, Vancouver, BC, Canada
| | - Celestino Rey-Joly
- Department of Internal Medicine and Lluita contra la SIDA and IrsiCaixa Foundations, Hospital Universitari Germans Trias i Pujol, Barcelona, Spain
| | - Bonaventura Clotet
- Department of Internal Medicine and Lluita contra la SIDA and IrsiCaixa Foundations, Hospital Universitari Germans Trias i Pujol, Barcelona, Spain
| | - B Clotet
- Hosp Univ Germans Trias i Pujol, Barcelona, Spain
| | - L Ruiz
- Hosp Univ Germans Trias i Pujol, Barcelona, Spain
| | | | - S Gel
- Hosp Univ Germans Trias i Pujol, Barcelona, Spain
| | - CR Fumaz
- Hosp Univ Germans Trias i Pujol, Barcelona, Spain
| | | | - A Bonjoch
- Hosp Univ Germans Trias i Pujol, Barcelona, Spain
| | - JC Martínez
- Hosp Univ Germans Trias i Pujol, Barcelona, Spain
| | - J Miranda
- Hosp Univ Germans Trias i Pujol, Barcelona, Spain
| | - J Puig
- Hosp Univ Germans Trias i Pujol, Barcelona, Spain
| | - ER Arisa
- Hosp Univ Germans Trias i Pujol, Barcelona, Spain
| | - A Tuldrà
- Hosp Univ Germans Trias i Pujol, Barcelona, Spain
| | - A Bonjoch
- Hosp Univ Germans Trias i Pujol, Barcelona, Spain
| | - A Jou
- Hosp Univ Germans Trias i Pujol, Barcelona, Spain
| | - C Tural
- Hosp Univ Germans Trias i Pujol, Barcelona, Spain
| | - G Sirera
- Hosp Univ Germans Trias i Pujol, Barcelona, Spain
| | - J Romeu
- Hosp Univ Germans Trias i Pujol, Barcelona, Spain
| | - E Negredo
- Hosp Univ Germans Trias i Pujol, Barcelona, Spain
| | - C Zala
- Fundacion Huesped, Buenos Aires, Argentina
| | - C Ochoa
- Fundacion Huesped, Buenos Aires, Argentina
| | - Pedro Cahn
- Fundacion Huesped, Buenos Aires, Argentina
| | - O Torres
- Hosp Santa Creu i Sant Pau, Barcelona, Spain
| | - P Domingo
- Hosp Santa Creu i Sant Pau, Barcelona, Spain
| | | | | | | | - F Vidal
- Hosp Joan XXIII, Tarragona, Spain
| | | | | | | | | | - R Mata
- Hosp Virgen del Rocío, Sevilla, Spain
| | - P Viciana
- Hosp Virgen del Rocío, Sevilla, Spain
| | - V Abril
- Hosp General Universitario, Valencia, Spain
| | - R Rubio
- Hosp 12 de Octubre, Madrid, Spain
| | | | | | | | - M Lonca
- Hosp Clínic, Barcelona, Spain
| | - I Ruiz
- Hosp del Valle Hebrón, Barcelona, Spain
| | - C Azuaje
- Hosp del Valle Hebrón, Barcelona, Spain
| | - E Pedrol
- Hosp de Granollers, Barcelona, Spain
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Ruiz L, Negredo E, Domingo P, Paredes R, Francia E, Balagué M, Gel S, Bonjoch A, Fumaz CR, Johnston S, Romeu J, Lange J, Clotet B. Antiretroviral treatment simplification with nevirapine in protease inhibitor-experienced patients with hiv-associated lipodystrophy: 1-year prospective follow-up of a multicenter, randomized, controlled study. J Acquir Immune Defic Syndr 2001; 27:229-36. [PMID: 11464141 DOI: 10.1097/00126334-200107010-00003] [Citation(s) in RCA: 63] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Simpler and less toxic antiretroviral strategies are needed to maximize treatment compliance without sacrificing potency, at least for drug-experienced HIV-infected patients currently on regimens containing protease inhibitors (PIs). Small nonrandomized studies have suggested a beneficial role of PI-sparing regimens on lipodystrophy. OBJECTIVES To assess the virologic, immunologic, and clinical benefit of switching the PI to nevirapine in patients with HIV-associated lipodystrophy and sustained viral suppression before entry in the study. DESIGN Open-labeled, prospective, randomized, multicenter study. SETTING Seven reference inpatient centers for HIV/AIDS in Spain. PATIENTS One hundred six HIV-infected adults with clinically evident lipodystrophy who sustained HIV-RNA suppression for at least 6 months with PI-containing antiretroviral combinations. INTERVENTION Replacement of the PI with nevirapine during 48 weeks (Group A) versus continuing the prior PI (Group B). MEASUREMENTS Several virologic and immunologic analyses, standard and specific biochemical tests, and anthropometric and dual X-ray absorptiometry measurements. RESULTS At week 48, an HIV-1 RNA level <400 copies/ml was maintained in 79% and 77% of patients in Groups A and B, respectively, whereas 74% and 72% of patients had viral load levels <50 copies/ml. Absolute CD4+ counts significantly increased in both groups compared with baseline values, and a significant decrease in CD38+CD8+ cells was observed in Group A (p <.01) but not in group B. Overall, no significant changes in anthropometric or body shape measurements were found after 48 weeks. Fasting total cholesterol and triglyceride levels decreased in Group A (but not in Group B) compared with baseline values (p <.05), although no significant differences were seen between groups at the end of the study. Subjects in Group A reported a better quality of life (QOL) index than controls (p <.001), with the main reason reported being the greater simplicity of the new drug regimen. CONCLUSIONS Protease inhibitor-sparing regimens, including nevirapine, seem to be an effective alternative for PI-experienced patients. Nevirapine-based triple therapies allow maintained control of HIV-1 RNA levels and improve the immunologic response at 48 weeks of follow-up in patients with prior sustained virologic suppression. The switch to nevirapine significantly improved the lipidic profile in Group A, although there were no differences between groups at the end of the study. Additionally, no significant changes were seen in terms of lipodystrophy-related body shape changes 1 year after the PI substitution. Finally, nevirapine-containing regimens have a simpler dosing schedule, and this facilitates high adherence and improves QOL.
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Affiliation(s)
- L Ruiz
- "IrsiCaixa" Foundation, Retrovirology Laboratory and HIV Unit, Hospital Universitari Germans Trias i Pujol, Badalona, Spain.
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Tuldrà A, Fumaz CR, Ferrer MJ, Bayés R, Arnó A, Balagué M, Bonjoch A, Jou A, Negredo E, Paredes R, Ruiz L, Romeu J, Sirera G, Tural C, Burger D, Clotet B. Prospective randomized two-Arm controlled study to determine the efficacy of a specific intervention to improve long-term adherence to highly active antiretroviral therapy. J Acquir Immune Defic Syndr 2000; 25:221-8. [PMID: 11115952 DOI: 10.1097/00126334-200011010-00003] [Citation(s) in RCA: 132] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
BACKGROUND Nearly perfect compliance seems to be indispensable to obtain the maximum benefit from highly active antiretroviral therapy (HAART). Interventions to ensure a high level of adherence during a relatively long-term period of therapy are necessary. METHODS This is a prospective, randomized, two-arm controlled study including patients starting their first-or second-line HAART who were randomized to receive psychoeducative intervention to implement adherence (experimental group [EG]) or a usual medical follow-up (control group [CG]). We aimed to study the efficacy of a psychoeducative intervention to ensure long-term adherence to HAART, its relation with the virologic efficacy of treatment, and to determine the variables related to long-term adherence. Visits were made at weeks 0, 4, 24, and 48 for data collection. Self-reported adherence was registered at each visit and its veracity was tested by randomized blood analyses performed without previous warning to 40% of patients. Appropriate adherence was defined as the consumption of >/=95% of medication prescribed. Statistical analyses were performed both by the as treated (AT) and the intention to treat missing = failure (ITT) methods. RESULTS In all, 116 patients were included. At week 48, 94% of patients in the EG versus 69% controls achieved adherence >/=95% (p =.008); 89% of patients in the EG versus 66% controls had HIV-1 RNA levels <400 copies/ml (p =.026). Overall, 85% of patients with adherence >/=95% but only 45% of those with adherence <95% had viral load (VL) <400 copies/ml (p =. 008). In multivariate analysis, variables significantly related to adherence were having received a psychoeducative intervention (odds ratio [OR], 6.58; p =.04), poor effort to take medication (OR, 5.38; p =.03), and high self-perceived capacity to follow the regimen (OR, 13.76; p =.04). Self-reported adherence and drug plasma levels coincided in 93% of cases. However, differences in adherence did not reach statistical significance in the ITT analysis although a clear tendency toward benefit was observed in EG. CONCLUSIONS Specific and maintained psychoeducative interventions based on excellence on clinical practice are useful to keep high levels of adherence as well as high levels of viral suppression. There is a clear relation between high adherence levels and virologic success. Assessment of certain specific variables related to adherence may be helpful to monitor patient's compliance in the clinical setting.
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Affiliation(s)
- A Tuldrà
- HIV Unit, "Fundació Lluita SIDA" and "IrsiCaixa" Retrovirology Laboratory, "Germans Trias i Pujol" University Hospital, Badalona, Spain.
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