The influence of depressive symptoms and substance use on adherence to antiretroviral therapy. A cross-sectional prevalence study

• Main Authors: Claudia Siqueira Tufano, Ricardo Abrantes do Amaral, Luciana Roberta Donola Cardoso, André Malbergier
• Format: Article
• Language: English
• Published: Associação Paulista de Medicina
• Series: São Paulo Medical Journal
• Subjects: HIV; Depression; Medication adherence; Antiretroviral therapy, highly active; Immune system
• Online Access: http://www.scielo.br/scielo.php?script=sci_arttext&pid=S1516-31802015000300179&lng=en&tlng=en

CONTEXT AND OBJECTIVE:Adherence to antiretroviral treatment (ART) is not a stable condition, but is dynamic, like mental conditions. The aim of this study was to examine whether non-adherence to ART is related to demographic and immunological variables, substance use and presence of depressive symptoms.DESIGN AND SETTING:This was a cross-sectional prevalence study carried out at a public AIDS treatment center in the city of São Paulo, Brazil, between July 2006 and January 2007.METHODS:438 patients on regular ART schedules with recent laboratory tests answered a demographic questionnaire, questions about substance use, the Hamilton Depression Rating Scale (HDRS) and the Simplified Medication Adherence Questionnaire (SMAQ).RESULTS:The prevalence of non-adherence over the past three months (a pattern of treatment interruption) was 46.3%, and 27.2% also reported this in the past week (a pattern of missed doses). ART interruption was significantly related to older age, lower CD4+ cell count and homosexual/bisexual transmission. The pattern of missed doses was significantly related to younger age, higher HDRS scores and higher viral load of RNA HIV.CONCLUSION:ART interruption may reflect recall errors and changes to the Brazilian demographic characteristics of HIV infection. The missed doses may reflect lifestyle characteristics of younger individuals. Attendance for HIV-positive individuals, particularly younger patients, should involve interventions and counseling in relation to the presence of depressive symptoms.