Publication: Estudio de factores de riesgo influyentes en el adherencia al tratamiento antirretroviral y desarrollo de un modelo predictivo en pacientes VIH positivos
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2016-03-08
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Universidad Complutense de Madrid
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Abstract
La aparición del tratamiento antirretroviral de gran actividad (TARGA) en los años 90, cambió por completo la situación de los pacientes infectados por el virus de la inmunodeficiencia humana (VIH). Este tratamiento supuso un antes y un después en el pronóstico de estos pacientes, ya que convirtió una infección de elevada mortalidad en una patología que a día de hoy se considera crónica consiguiendo reducir las complicaciones relacionadas con el virus, a través de un mejor control de la carga viral plasmática y los niveles de linfocitos CD4 Es precisamente este cambio hacia la cronicidad el que ha hecho que en los últimos años la adherencia sea una de las cuestiones más importantes a considerar a la hora de conseguir unos resultados clínicos óptimos entre los pacientes con VIH. Es por ello, que el objetivo principal de esta tesis doctoral es evaluar un conjunto de factores de diversa índole (sociodemográficos, epidemiológicos, clínicos y farmacológicos), con el fin de determinar cuáles de ellos tienen una influencia sobre la adherencia al TAR. Asimismo, los objetivos secundarios fueron determinar el grado de adherencia de los pacientes a su tratamiento y a los horarios de toma de medicación, clasificar los factores que influyen la adherencia según la percepción de los propios pacientes y el desarrollo de un modelo predictivo de adherencia entre los pacientes adultos VIH. Para ello se diseñó un estudio observacional, descriptivo y prospectivo, que incluyó a pacientes con VIH mayores de 18 años, en tratamiento con cualquiera de las combinaciones posibles de fármacos antirretrovirales, que estuvieron en tratamiento, al menos, durante los 6 meses previos al inicio del estudio con la misma combinación de fármacos y que recogieron su medicación en el Servicio de Farmacia del Hospital Universitario de Getafe. Aceptaron participar en el estudio un total de 229, de los cuales finalmente 211 cumplieron los criterios de inclusión, obteniéndose una muestra balanceada y representativa de los pacientes adultos VIH españoles. La adherencia se midió a través de dos métodos indirectos: registro de dispensación de medicación (obtenido del módulos de pacientes externos de la aplicación Farmatools®) y cuestionario de adherencia SMAQ. Además, se decidió crear un tercer grupo que clasificó como adherentes a todos los pacientes tipificados como tales según ambos métodos...
The arrival of high activity antiretroviral therapy (HAART) in the early nineties changed the situation of HIV patients completely. This treatment marked a before and after on these patients forecast. It turned a high-mortality infection into what today is considered as a chronic disease by reducing the virus related complications through a better control of the plasmatic viral load and the CD4 lymphocyte levels. It is this very change into chronicity what has made adherence one of the most important things to consider when accomplishing optimum clinical results amongst HIV-infected patients. This is why the main objective of this PhD thesis is to evaluate a sum of different factors (sociodemographic, epidemiological, clinical and pharmacological) in order to determine which of them has an influence over the adherence of HAART. Also, the secondary objectives are: to assess the level of adherence of patients to their treatment, to determine the times in which they take the tablets, to classify the factors that influence on the adherence on the own patient’s perception, and to develop a predictive adherence model amongst adult HIV patients. For this purpose a descriptive and prospective observational study was designed. It included HIV-infected patients who were over 18, and on treatment with any of the possible HAART drugs combinations, and who were on treatment for at least 6 months prior to the beginning of the study, collecting their medicines from the pharmacy department at Universitary Hospital of Getafe. Overall, 229 people accepted to participate in the study, of which 211 were eligible to do so. We got a representative and balanced sample of the adult HIV-infected spanish patients. Adherence was measured by two indirect different methods: a dispensing record (got from the Farmatools® app) and the SMAQ adherence questionnaire. A third group was also created. This will classify as adherent all those patients who are found out as so in both previous methods. The second question from the SMAQ questionnaire was used to measure how many patients took their drugs at the right time every day (adherent to their medication schedule)...
The arrival of high activity antiretroviral therapy (HAART) in the early nineties changed the situation of HIV patients completely. This treatment marked a before and after on these patients forecast. It turned a high-mortality infection into what today is considered as a chronic disease by reducing the virus related complications through a better control of the plasmatic viral load and the CD4 lymphocyte levels. It is this very change into chronicity what has made adherence one of the most important things to consider when accomplishing optimum clinical results amongst HIV-infected patients. This is why the main objective of this PhD thesis is to evaluate a sum of different factors (sociodemographic, epidemiological, clinical and pharmacological) in order to determine which of them has an influence over the adherence of HAART. Also, the secondary objectives are: to assess the level of adherence of patients to their treatment, to determine the times in which they take the tablets, to classify the factors that influence on the adherence on the own patient’s perception, and to develop a predictive adherence model amongst adult HIV patients. For this purpose a descriptive and prospective observational study was designed. It included HIV-infected patients who were over 18, and on treatment with any of the possible HAART drugs combinations, and who were on treatment for at least 6 months prior to the beginning of the study, collecting their medicines from the pharmacy department at Universitary Hospital of Getafe. Overall, 229 people accepted to participate in the study, of which 211 were eligible to do so. We got a representative and balanced sample of the adult HIV-infected spanish patients. Adherence was measured by two indirect different methods: a dispensing record (got from the Farmatools® app) and the SMAQ adherence questionnaire. A third group was also created. This will classify as adherent all those patients who are found out as so in both previous methods. The second question from the SMAQ questionnaire was used to measure how many patients took their drugs at the right time every day (adherent to their medication schedule)...
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Tesis inédita de la Universidad Complutense de Madrid, Facultad de Farmacia, Departamento de Farmacología, leída el 26-11-2015