Associação entre uso de álcool em indivíduos com AIDS e adesão ao tratamento antirretroviral: uma revisão da literatura

Relations of drug use and socioeconomic factors with adherence to dental treatment among adolescents

Background

Adolescents are vulnerable to behaviors that weaken health, by adopting habits that interfere with adherence to treatment. The aims of the present study were to investigate adolescents’ adherence to dental treatment and the relations between this behavior and socioeconomic factors and consumption of licit and illicit chemical substances.

Methods

A longitudinal study was conducted with 474 adolescents from Piracicaba/SP/Brazil, who initially underwent a dental examination to verify the adherence for dental treatment. After 18 months, 325 adolescents were reassessed. Valid questions about socioeconomic conditions and use of alcohol and drugs were applied to participants. The chi-square test and Fisher’s exact test were used. The prevalence ratios were estimated with the respective 95% confidence intervals, using generalized linear models with Poisson distribution.

Results

Eighteen (18) months after the first consultation, 325 adolescents were reassessed: 161 (49%) did not adhere to the treatment, and 164 (51%) adhered to it and answered the socioeconomic and alcohol and illicit drug questionnaires. Their mean age was 15 ± 1 years; of them, 189 (58%) were female. The prevalence of adherence to treatment decreased in patients without their own home (p = 0.034). In the individual analysis of the variables, drinking alcohol alone, experimenting with drugs, and proximity of friends who consumed illicit substances were associated with the outcome (p < 0.05). However, in the joint analysis, only proximity of friends who consumed drugs was the factor related to low adherence to dental treatment among the adolescents (p = 0.035).

Conclusion

Adolescents who consumed alcohol and socialized with friends who used illicit drugs had greater difficulty in adhering to dental treatment.

Profile of infected pregnant women and children exposed to HIV at a specialized service in the South of Brazil

Abstract Objectives: to characterize the social and clinical profile of pregnant women infected with HIV, the factors associated to the prevention of vertical transmission, and to analyze the quality of the information available in the SINAN notification forms and clinical records of infected pregnant women and children exposed to HIV in a specialized service in the countryside of Rio Grande do Sul. Methods: retrospective documentary study conducted from medical records of 110 HIV mothers and their children born between June/2014 and March/2017. For the analysis, the absolute frequency and the data percentage were taken under consideration. Results: the characterization of infected women represents a Brazilian scenario among young adults, low schooling level and the occurrence of unpaid employment situation. Most mothers underwent treatment during pregnancy and had prenatal care with the intention of applying the prophylactic measures recommended by the national protocols. A greater occurrence of incompleteness of data in the factors of prevention of vertical transmission was identified. Conclusions: the compromise is identified regarding the quality of assistance addressed to the population, which is largely exposed to unfavorable social conditions. The occurrence of data incompleteness shows that there is still not a culture among health professionals that ensures that the information is adequately filled out and favors the exchange of the information among the services.

Viral suppression and adherence among HIV-infected children and adolescents on antiretroviral therapy: results of a multicenter study

OBJECTIVE

To evaluate treatment adherence among perinatally-infected pediatric human immunodeficiency virus (HIV) patients followed in pediatric centers in Brazil.

METHODS

This was a cross-sectional multicenter study. Medical records were reviewed and adherence scale, assessment of caregivers' quality of life (WHOQOL-BREF), anxiety, depression, and alcohol/substances use/abuse were assessed. Outcomes included self-reported 100% adherence in the last three days and HIV viral load (VL)<50 copies/mL. Statistical analyses included contingency tables and respective statistics, and multivariable logistic regression.

RESULTS

260 subjects were enrolled: 78% children and 22% adolescents; 93% of caregivers for the children and 77% of adolescents reported 100% adherence; 57% of children and 49% of adolescents had VL<50 copies/mL. In the univariate analyses, HIV diagnosis for screening due to maternal infection, lower caregiver scores for anxiety, and higher scores in physical and psychological domains of WHOQOL-BREF were associated with 100% adherence. Shorter intervals between pharmacy visits were associated with VL<50 copies/mL (p ≤ 0.01). Multivariable regression demonstrated that caregivers who did not abuse alcohol/other drugs (OR=0.49; 95% CI: 0.27-0.89) and median interval between pharmacy visits<33 days (OR=0.97; 95% CI: 0.95-0.98) were independently associated with VL<50 copies/mL; whereas lower caregiver scores for anxiety (OR=2.57; 95% CI: 1.27-5.19) and children's HIV diagnosis for screening due to maternal infection (OR=2.25; 95% CI: 1.12-4.50) were found to be independently associated with 100% adherence.

CONCLUSIONS

Pediatric HIV programs should perform routine assessment of caregivers' quality of life, and anxiety and depression symptoms. In this setting, pharmacy records are essential to help identify less-than-optimal adherence.

O remédio é o menor dos problemas: seguindo redes na adesão ao tratamento de aids

Este texto buscou problematizar a proposta metodológica de Bruno Latour. Numa pesquisa sobre pessoas vivendo com HIV (Vírus da imunodeficiência humana) e seus dilemas de adesão, valendo-nos da proposta de Latour, buscamos trabalhar com as seguintes questões: como efetuar uma aproximação aos universos das pessoas vivendo com HIV sem fracionar a vida das pessoas? Como compreender as relações que a PVHIV (Pessoas vivendo com HIV) estabelece com a medicação sem separar a questão da administração medicamentosa do restante das experiências? Apesar dos percalços, comuns àqueles que se dedicam a seguir itinerários (os perigos da travessia, diria Guimarães Rosa), a pesquisa guiada pela metodologia proposta por Latour – a metodologia etnográfica da “Teoria Ator-Rede” – permitiu, ainda que tímida e inicialmente, seguir os passos de atores, sem fracionar as suas vidas, sem fazer recortes isolados, acompanhando o que acontece em rede e está interligado, interferindo e sofrendo interferências. A etnografia realizada nos levou por caminhos tortuosos, fazendo-nos embrenhar em itinerários confusos, em redes de humanos e não humanos, de remédios, piscinas, Organização Não Governamental (ONG), serviços de saúde, uma rede de relações de pessoas vivendo com HIV nos caminhos difíceis que nossos interlocutores elaboraram.

Estudo do autorrelato de adesão e uso problemático de álcool em uma população de indivíduos com AIDS em uso de HAART

OBJETIVO: O objetivo deste estudo foi analisar a força de associação entre as variáveis autorrelato de adesão à medicação e uso problemático de álcool em uma população de indivíduos com AIDS que fazem uso de HAART. MÉTODO: Foram entrevistados 103 pacientes com AIDS, em uso de HAART há pelo menos seis meses, que frequentavam o ambulatório do Instituto de Doenças Tropicais Natan Portela (IDTNP), localizado na cidade de Teresina, PI. A variável independente estudada foi o uso problemático de álcool, além de variáveis sociodemográficas. O questionário utilizado para avaliar o uso problemático de álcool foi o AUDIT (Alcohol Use Disorders Identification Test). A variável dependente avaliada neste estudo foi o autorrelato de adesão ao tratamento para o HIV. Para sua mensuração, optou-se por utilizar o QSAM (Questionário Simplificado de Adesão à Medicação), por tratar-se de um questionário bastante simples e de fácil aplicação. RESULTADOS: A frequência de AUDIT > 08 foi de 33%; já o autorrelato de adesão, avaliado pelo QSAM, foi positivo em 45% da amostra. Testada a associação entre a frequência de QSAM positivo e o AUDIT positivo, encontrou-se forte associação entre essas variáveis (p = 0,004). CONCLUSÃO: Conclui-se deste estudo que o autorrelato de falha na adesão ao HAART aferido por meio do QSAM é um fator de risco para a presença de uso problemático de álcool.