Sociodemographic and psychological variables influencing adherence to antiretroviral therapy

Objective: To assess the degree of compliance with antiretroviral therapy i n HIV-infected patients, and identify which sociodemographic and psychologi cal factors influence it, in order to develop strategies to improve adheren ce. Design and setting: Cross-sectional study in a reference HIV/AIDS instituti on located in Madrid, Spain. Patients and methods: A total of 366 HIV-infected patients who were on trea tment with antiretroviral drugs were invited to complete a questionnaire wh ich recorded sociodemographic data and psychological variables in relation to compliance with the prescribed medication. Clinical information was extr acted from the hospital records. The Beck Depression inventory was used to assess depression, while adherence to treatment was evaluated using patient 's self report and the pill count method. Results: A good adherence to antiretroviral therapy (> 90% consumption of t he prescribed pills) was recorded in 211 (57.6%) patients. A good concordan ce for assessing adherence was found using the patient's self-report and th e pill count method in a sub-group of patients. Predictors: of compliance i n the univariate analysis were age, transmission category, level of studies , work situation, CD4 cell count level, depression and self-perceived socia l support. In the multivariate model, only age, transmission category, CD4 cell count level, depression, self-perceived social support, and an interac tion between the last two variables predicted compliance to treatment; adhe rence to antiretroviral therapy was better among subjects aged 32-35 years [odds ratio (OR), 2.31; 95% confidence interval (CI), 1.21-4.40], in non-in travenous drug users (IVDUs) (OR, 2.05; 95% Cl, 1.28-3.29), subjects with C D4 cell counts from 200-499 x 10(6) cells/l at enrolment (OR, 2.78; 95%Cl, 1.40-5.51) and in subjects not depressed and with a self-perceived good soc ial support (OR 1.86; 95% Cl, 0.98-3.53). Conclusions: Sociodemographic and psychological factors influence the degre e of adherence to antiretroviral therapy. Overall,: IVDUs and younger indiv iduals tend to have a poorer compliance, as well as subjects with depressio n and lack of self-perceived social support. An increased awareness of thes e factors by practitioners attending HIV-infected persons, recognizing and potentially treating some of them, should indirectly improve the effectiven ess of antiretroviral therapy. (C) 1999 Lippincott Williams & Wilkins.