Adesão à Terapêutica Anti-Retrovírica na Infecção VIH/SIDA

Revisão de Artigos Publicados

Ângela Ventura*†

*Serviços Farmacêuticos, Hospital Joaquim Urbano; † Serviço de Higiene e Epidemiologia, Faculdade de Medicina da Universidade do Porto

 

Resumo

Foi conduzida uma pesquisa na MEDLINE entre 1996 e 2004 a fim de identificar artigos onde a adesão à terapêutica e a infecção VIH/sida estivessem relacionadas. Na revisão bibliográfica subsequente foram incluídos 32 artigos, decorrentes da investigação em adultos (acima de 18 anos) e cujo objectivo principal foi quantificar a adesão à terapêutica de doentes com infecção VIH/sida. Foi registada informação relativa à definição de adesão, ao local de realização e desenho do estudo, à amostra, aos métodos de avaliação e aos níveis de adesão à terapêutica obtidos. As variáveis preditoras de adesão foram agrupadas de acordo com o conceito que pretendiam representar. Estes grupos foram organizados em três grandes categorias: a) factores sociais, b) factores relacionados com a doença e c) factores relacionados com o tratamento. A opção mais escolhida foi a de considerar a adesão como uma variável categórica. A entrevista e o questionário foram os métodos mais utilizados, apesar da diversidade de métodos para avaliar a adesão. Os estudos realizados foram maioritariamente observacionais prospectivos. A proveniência dos participantes foi sobretudo hospitalar com predomínio do sexo masculino. Os níveis de adesão à terapêutica encontrados, nos vários artigos, estão, na maior parte dos casos, abaixo do necessário para obter sucesso clínico. As variáveis que em mais estudos se associaram com a baixa adesão à terapêutica foram: o baixo nível de escolaridade e estatuto sócio-económico, a depressão, a falta de motivação para o tratamento e a complexidade do regime terapêutico.

Palavras-chave: adesão; infecção VIH/sida; terapêutica anti-retrovírica; revisão

 

Abstract

Adherence to Anti-Retroviral Therapy in HIV

A literature search was conducted on the MEDLINE database, for the years 1996 to 2004, to collect published articles correlating HIV infection and adherence. Thirty two article were included; we limited to articles in adult human subjects (aged 18 or older) and when the major objective was to determine the prevalence of non-adherence treatment in HIV patients. This review examined adherence definition, study design and methodology, subjects characteristics and measurement of adherence. The barriers to optimal adherence were organized in three major groups: a) Social and psychological factors, b) factors related with the disease and c) factors related to treatment regimen. Most studies used a categorical definition of adherence. By far, the most frequent used methods were interviews and questionnaires. The study designs were primarily prospective and most commonly in hospital-based settings. Man were prevalent in most samples. In most studies adherence was incomplete and difficult to achieve. Social-economic factors, as lower income and lower educational level were negatively associated with adherence. Depression, lack of motivation and complexity of regimen were also related with poor adherence.

Key-words: adherence; HIV infection; anti-retroviral therapy; literature review

 

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Correspondência:

Dr.ª Ângela Ventura Hospital de Joaquim Urbano

Serviços Farmacêuticos

Rua Câmara Pestana, 348 4000 Porto

e-mail: angelav@hjurbano.min-saude.pt