review article
10.25176/RFMH.v24i4.5785
FACTORS ASSOCIATED WITH POOR ADHERENCE TO HAART IN PATIENTS WITH HIV DURING THE COVID-19 PANDEMIC
FACTORES ASOCIADOS A MALA ADHERENCIA AL TARGA EN PACIENTES CON VIH DURANTE LA PANDEMIA POR LA COVID-19
1 Medical Student
2 Master of Medicine
3 Psychologist
4 PhD in Clinical and Translational Research
aUniversidad Privada Antenor Orrego. School of Human Medicine. Trujillo, Peru.
bUniversidad Privada Antenor Orrego. Graduate School. Trujillo, Peru.
cUniversidad César Vallejo. School of Psychology. Trujillo, Peru.
Abstract
Introduction: In the COVID-19 pandemic, the fear of contagion and the risk of poor evolution were conditions that circumscribed HIV-infected patients, potentially influencing adherence to HAART (A-HAART). Objective: To determine the factors associated with poor adherence to HAART (PA-TARGA) in patients with HIV during the COVID-19 pandemic in a hospital in northern Peru during April-October 2021. Material and Methods: A study was developed cross-sectional analytical study in 162 patients with a confirmed diagnosis of HIV infection on HAART. To establish A-HAART, the Morisky-Green-Levine Test was used. The association between sociodemographic, personal/family factors of COVID-19, health, and PA-HAART was evaluated using the Pearson Chi-square test, considering statistical significance for a p value < 0.05. The risk statistic was the Odds ratio (OR) > 1. Results: The prevalence of PA-HAART was 32%, the mean age 45.8±8.3 and 44.6±7.3 years (with poor and good adherence to HAART), predominantly male. Factors associated with PA-HAART were living alone (p=0,036, OR:3,1), personal history of COVID-19 (p=0,027, OR: 2,42), history of a close relative with COVID-19 (p =0,038, OR 3,42), depression (p=0,036, OR: 2,18) and comorbidity (p=0,027, OR: 2,21). Conclusion: In patients with HIV, living alone, a personal history of COVID-19, a history of a close relative with COVID-19, depression and presenting comorbidity are factors associated with PA-HAART.
Keywords:
Associated factor, poor adherence, HAART, HIV
Resumen
Introducción: En la pandemia por la COVID-19, el temor al contagio y el riesgo de una mala evolución, fueron condiciones que circunscribieron a los pacientes infectados por el VIH, lo que influyó potencialmente en la adherencia al TARGA (A-TARGA). Objetivo: Determinar los factores asociados a la mala adherencia al TARGA (MA-TARGA) en pacientes con VIH durante la pandemia por la COVID-19 en un hospital del norte del Perú durante abril-octubre del año 2021. Material y Métodos: Se desarrolló una investigación analítica transversal en 162 pacientes con diagnóstico confirmado de infección por VIH en TARGA. Para establecer la A-TARGA, se usó el Test de Morisky-Green-Levine. Se evaluó la asociación entre factores sociodemográficos, personales/familiares de COVID-19, de salud y la MA-TARGA mediante la prueba de Chi Cuadrado de Pearson y se consideró significancia estadística para un valor p < 0,05. El estadígrafo de riesgo fue el Odds ratio (OR) > 1. Resultados: La prevalencia de MA-TARGA fue del 32 %, la media de edad 45,8±8,3 y 44,6±7,3 años (con mala y buena adherencia al TARGA); predominó el sexo masculino. Fueron factores asociados a MA-TARGA: Vivir solo (p=0,036, OR:3,1), antecedente personal de COVID-19 (p=0,027, OR: 2,42), antecedente de familiar cercano con COVID-19 (p=0,038, OR 3,42), depresión (p=0,036, OR: 2,18) y comorbilidad (p=0,027, OR: 2,21). Conclusión: En pacientes con VIH, vivir solo, antecedente personal de COVID-19, antecedente de familiar cercano con COVID-19, depresión y presentar comorbilidad, son factores asociados a MA-TARGA.
Palabras clave:
Factor asociado, mala adherencia, TARGA, VIH
Introduction
In March 2020, the World Health Organization (WHO) declared the 2019 coronavirus disease (COVID-19) a pandemic
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, which caused repercussions and concern in the general population
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. Since the beginning of the pandemic until the present day, there have been 676,609,955 confirmed cases of COVID-19 worldwide, with a total of 6,881,955 deaths attributed to this disease
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.In Peru, the total number of patients diagnosed with COVID-19 to date is 1,346,232, with a cumulative total of 219,663 deaths and a fatality rate of 4.89%
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People living with HIV (PLHIV) are at risk of contracting COVID-19 and exhibit similar progression patterns compared to HIV-negative individuals. It has become evident that multiple comorbidities and older age in PLHIV are associated with severe morbidity and death from COVID-19
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5.Cooper TJ, Woodward BL, Alom S, Harky A. Coronavirus disease 2019 (COVID-19) outcomes in HIV/AIDS patients: a systematic review. HIV Med. 2020; 21(9):567-577. DOI: https://doi.org/10.1111/hiv.12911.
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6. Mirzaei H, McFarland W, Karamouzian M, Sharifi H. COVID-19 among people living with HIV: a systematic review. AIDS Behav. 2021; 25(1):85-92. DOI: https://doi.org/10.1007/s10461-020-02983-2.
. It is essential to address comorbidities in PLHIV, ensure the continuity of their highly active antiretroviral therapy (HAART), and consider them a vulnerable population
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7. Paredes JL, Navarro R, Cabrera DM, Diaz MM, Mejía F, Caceres CF. Los desafíos en la continuidad de atención de personas viviendo con VIH en el Perú durante la pandemia de la COVID-19. Rev Peru Med Exp Salud Publica. 2021; 38(1):166-70. DOI: https://doi.org/10.17843/rpmesp.2021.381.6471.
.
Within the pandemic scenario, the fear of becoming infected and having a poor outcome persists among these patients, especially in light of potential complications. This situation likely influences good adherence to HAART
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8.Posada-Vergara MP, Alzate-Ángel JC, Martínez-Buitrago E. COVID-19 and VIH. Colomb Med (Cali). 2020; 51(2): e4327. DOI: https://doi.org/10.25100/cm.v51i2.4327.
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. Since HIV infection has become a chronic disease, HAART is now used long-term and initiated early
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11. Boyd MA, Boffito M, Castagna A, Estrada V. Rapid initiation of antiretroviral therapy at HIV diagnosis: definition, process, knowledge gaps. HIV Med. 2019; 20 Suppl 1:3-11. DOI: https://doi.org/10.1111/hiv.12708.
. Treatment response is conditioned by numerous interdependent factors, including non-compliance, which can lead to therapeutic regimen failure
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12. Abdulrahman SA, Ganasegeran K, Rampal L, Martins OF. HIV treatment adherence - a shared burden for patients, health-care providers, and other stakeholders. AIDS Rev. 2019;21(1):28-39. DOI: https://doi.org/10.24875/AIDSRev.19000037.
.
The health sector crisis caused by COVID-19 and the measures imposed to control the pandemic can pose a significant challenge for PLHIV, especially in low- and middle-income countries like Peru
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7. Paredes JL, Navarro R, Cabrera DM, Diaz MM, Mejía F, Caceres CF. Los desafíos en la continuidad de atención de personas viviendo con VIH en el Perú durante la pandemia de la COVID-19. Rev Peru Med Exp Salud Publica. 2021; 38(1):166-70. DOI: https://doi.org/10.17843/rpmesp.2021.381.6471.
. While adherence is crucial for long-term treatment efficacy, it is a dynamic factor and, therefore, difficult to assess. The interaction between adherence and response to HAART requires communication among the entire multidisciplinary care team
13-
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13. Rogers A, Brazier E, Dzudie A, Adedimeji A, Yotebieng M, Muhoza B, et al. COVID-19 associated changes in HIV service delivery over time in Central Africa: results from facility surveys during the first and second waves of the pandemic. PLoS One. 2022; 17(11): e0275429. DOI: https://doi.org/10.1371/journal.pone.0275429.
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18. Ahmed A, Dujaili JA, Jabeen M, Umair MM, Chuah L-H, Hashmi FK, et al. Barriers and enablers for adherence to antiretroviral therapy among people living with HIV/AIDS in the era of COVID-19: a qualitative study from Pakistan. Front. Pharmacol. 2022; 12: 807446. DOI: https://doi.org/10.3389/fphar.2021.807446.
.
Reports on good adherence to HAART vary depending on the health context of each nation and the influence of the COVID-19 pandemic. Countries such as India
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17. EChakraborty A, Hershow RC, Qato DM, Stayner L, Dworkin MS. Adherence to antiretroviral therapy among HIV patients in India: a systematic review and meta-analysis. AIDS Behav. 2020; 24(7): 2130-48. DOI: https://doi.org/10.1007/s10461-020-02779-4.
, Ethiopia
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19. Zewude SB, Ajebe TM. Magnitude of optimal adherence and predictors for a low level of adherence among HIV/ AIDS-infected adults in South Gondar zone, Northwest Ethiopia: a multifacility cross-sectional study. BMJ Open 2022; 12: e056009. DOI: https://doi.org/10.1136/ bmjopen-2021-056009.
, and Brazil
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20.Cunha GH, Lima MAC, Siqueira LR, Fontenele MSM, Ramalho AKL, Almeida PC. Lifestyle and adherence to antiretrovirals in people with HIV in the COVID-19 pandemic. Rev Bras Enferm. 2022; 75(Suppl 2): e20210644. https://doi.org/10.1590/0034-7167-2021-0644.
have reported adherence rates of 77%, 81.5%, and 88.7%, respectively. However, in pre-pandemic periods, countries like Cuba already had low HAART adherence rates (70.5%), demonstrating that this topic was already being addressed inefficiently
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21. Pérez-Bastán J, Viana-Castaño L. Factores asociados a la no adherencia terapéutica a los antirretrovirales en personas con VIH/SIDA. Revista Cubana de Medicina Tropical 2020; 72(2). [Accesado el 06 de Abril de 2023]. Available in: https://revmedtropical.sld.cu/index.php/medtropical/article/view/499
. In a Peruvian study conducted during the current pandemic, Barrera-Espinoza RW et al.
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22. Barrera-Espinoza RW, Gómez-Gonzales WE, Girón-Vargas A, Arana-Escobar M, Nieva-Villegas LM, Gamarra-Bustillos C, et al. Factores asociados a la no adherencia al tratamiento antirretroviral en personas con VIH/SIDA. Horiz Med 2021; 21(4): e1498. DOI: https://doi.org/10.24265/horizmed.2021.v21n4.09.
found that 82.9% of patients with HIV showed poor adherence to HAART.
The COVID-19 pandemic overwhelmed healthcare systems, especially public services, where routine care was restricted, and progressive panic spread. Day by day, hospitals faced increasing pressure to care for SARS-CoV-2-infected patients. However, special attention populations, such as people living with HIV, faced the risk of contracting SARS-CoV-2 when seeking hospital care and, at the same time, the risk of interrupting continuous care in HAART programs due to various implemented restrictions
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15. SeyedAlinaghi S, Mirzapour P, Pashaei Z, Afzalian A, Tantuoyir MM, Salmani R, et al. The impacts of COVID-19 pandemic on service delivery and treatment outcomes in people living with HIV: a systematic review. AIDS Res Ther. 2023; 20(1): 4. DOI: https://doi.org/10.1186/s12981-022-00496-7.
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20.Cunha GH, Lima MAC, Siqueira LR, Fontenele MSM, Ramalho AKL, Almeida PC. Lifestyle and adherence to antiretrovirals in people with HIV in the COVID-19 pandemic. Rev Bras Enferm. 2022; 75(Suppl 2): e20210644. https://doi.org/10.1590/0034-7167-2021-0644.
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22.Barrera-Espinoza RW, Gómez-Gonzales WE, Girón-Vargas A, Arana-Escobar M, Nieva-Villegas LM, Gamarra-Bustillos C, et al. Factores asociados a la no adherencia al tratamiento antirretroviral en personas con VIH/SIDA. Horiz Med 2021; 21(4): e1498. DOI: https://doi.org/10.24265/horizmed.2021.v21n4.09.
. In this context, the present study aimed to investigate the factors associated with poor HAART adherence in patients living with HIV, as therapeutic efficacy depends on adequate compliance.
Materials and Methods
Study Design
During the period from April to October 2021, a cross-sectional analytical study was conducted on 162 HIV-infected patients receiving HAART at the Hospital Regional Docente de Trujillo, in the La Libertad region of Peru.
Selection Criteria
he study included individuals of both sexes aged ≥ 18 years who had previously received care in the mental health area (psychiatry and/or psychology) and who provided their consent by phone for participation. Patients in the terminal phase of illness, bedridden, with severe mental disorders (e.g., major depressive disorder, dementia, schizophrenia), or those who decided to withdraw or did not complete the required data were excluded.
Procedures
The informed consent form was read to the participants over the phone, explicitly detailing its content, with emphasis on its recording. Their approval to participate was duly recorded. A data collection instrument was structured, consisting of two sections: one that gathered sociodemographic data (age, sex, marital status, education level, residence, living alone) and clinical history (disease duration, anxiety, depression, comorbidity, personal history of COVID-19, family history of COVID-19), and another that included the Morisky-Green-Levine Test.
Statistical Analysis
SPSS 28.0 statistical software was used for data processing and information generation. Absolute and relative frequencies were used, along with measures of central tendency (mean and median) and measures of dispersion (standard deviation). Pearson's Chi-square test was used to assess the independence between associated factors and poor adherence to HAART, with statistical significance considered for p-values < 0.05 and risk for OR > 1.
Ethical Aspects
The study fully complied with Peru's General Health Law 23 ➤23. Ley que establece los derechos de las personas usuarias de los servicios de la salud. Ley N° 29414. Perú, 2009. [Accesado el 06 de Abril de 2023]. Available in: https://www.leyes.congreso.gob.pe/Documentos/Leyes/29414.pdf. and the Declaration of Helsinki 24 ➤
24. Asociación Médica Mundial. Declaración de Helsinki de la AMM – Principios éticos para las investigaciones médicas en seres humanos. Helsinsky: Asociación Médica Mundial; 2013. [Accesado el 06 de Abril de 2023]. Available in: https://medicina.udd.cl/centro-bioetica/files/2010/10/declaracion_helsinski.pdf. 25 ➤
25. Colegio Médico del Perú. Código de ética y deontología. Lima: Colegio Médico del Perú; 2007. [Accesado el 06 de Abril de 2023]. Available in: https://www.cmp.org.pe/wp-content/uploads/2020/01/CODIGO-DE-ETICA-Y-DEONTOLOG%C3%8DA.pdf. , ensuring that participants' rights and interests were never compromised. Respect for all patients and their individual rights—such as information integrity, confidentiality, anonymity, and respect for their decisions—was promoted and guaranteed, as evidenced by the informed consent process. The content of medical records was neither altered nor falsified. Additionally, the study was approved by the Universidad Privada Antenor Orrego (Bioethics Committee Resolution No. 0017-2023-UPAO) and the Hospital Regional Docente de Trujillo (Authorization Certificate from the Office of Support for Teaching and Research).
RESULTS
Sociodemographic factors
The adherence to HAART in HIV patients was 68%. For patients with poor HAART adherence (PA-HAART) and good HAART adherence (A-HAART), the average age was 45.8 ± 8.3 and 44.6 ± 7.3 years, respectively. Regarding the duration of the disease, it was 7.2 ± 3.5 years and 6.8 ± 3.3 years, respectively. In both groups, males predominated, and secondary education was the most frequent educational level. The majority of participants were single, lived in urban areas, and few lived alone. Only the condition of living alone was associated with poor adherence to HAART (p=0.036, OR: 3.1, 95% CI: 1.5-6.3).
Table 1.
Sociodemographic factors associated with poor adherence to HAART in HIV patients during the COVID-19 pandemic.
| Sociodemographic factors | Poor adherence | Good adherence | OR IC 95% | p-value | ||
|---|---|---|---|---|---|---|
| n | % | n | % | |||
| 52 | 32% | 110 | 68% | |||
| Age | 45,8 ± 8,3 | 44,6 ± 7,3 | NA | 0,15 | ||
| Duration of illness | 7,2 ± 3,5 | 6,8 ± 3,3 | NA | 0,33 | ||
| Sex | ||||||
| Male | 35 | 67% | 69 | 63% | 1,22 (0,6-2,3) | 0,68 |
| Female | 17 | 33% | 41 | 37% | ||
| Education Level | ||||||
| No formal education | 6 | 12% | 10 | 9% | 1,23 (0,5-1,9) | 0,66 |
| Primary | 11 | 21% | 21 | 19% | ||
| Secondary | 22 | 42% | 46 | 42% | ||
| Higher | 13 | 25% | 33 | 30% | ||
| Marital status | ||||||
| Single | 34 | 65% | 62 | 56% | 1,46(0,7-2,2) | 0,56 |
| Cohabiting | 14 | 27% | 38 | 35% | ||
| Married | 4 | 8% | 10 | 9% | ||
| Residence | ||||||
| Urban | 49 | 94% | 105 | 95% | 0,77 (0,4-1,6) | 0,48 |
| Rural | 3 | 6% | 5 | 5% | ||
| Lives Alone | ||||||
| Yes | 14 | 27% | 12 | 11% | 3,1 (1,5-6,3) | 0,036 |
| No | 38 | 73% | 98 | 89% | ||
Personal/Family Factors
A personal history of having had COVID-19 (p=0.027, OR: 2.42, 95% CI: 1.2-3.9) and a close family member's history of COVID-19 (p=0.038, OR: 3.42, 95% CI: 1.8-6.9) were associated with poor adherence to HAART.
Table 2.
Personal/family history factors of COVID-19 associated with poor adherence to HAART in HIV patients during the COVID-19 pandemic.
| Personal/Family History of COVID-19 Factors | Poor adherence | Good adherence | OR IC 95% | p-value | ||
|---|---|---|---|---|---|---|
| n | % | n | % | |||
| 52 | 32% | 110 | 68% | |||
| Personal history of COVID-19 | ||||||
| Yes | 36 | 69% | 53 | 48% | 2,42 (1,2-3,9) | 0,027 |
| No | 16 | 31% | 57 | 52% | ||
| Family member's history of COVID-19 | ||||||
| Yes | 33 | 64% | 37 | 34% | 3,42 (1,8-6,9) | 0,038 |
| No | 19 | 36% | 73 | 66% | ||
Health factors:
Depression (p=0.036, OR: 2.18, 95% CI: 1.4-5.1) and the presence of comorbidities (p=0.027, OR: 2.21, 95% CI: 1.3-4.9) were associated with poor adherence to HAART.
Table 3.
Health factors associated with poor adherence to HAART in HIV patients during the COVID-19 pandemic.
| Health factors | Poor adherence | Good adherence | OR IC 95% | p-value | ||
|---|---|---|---|---|---|---|
| n | % | n | % | |||
| 52 | 32% | 110 | 68% | |||
| Anxiety | ||||||
| Yes | 21 | 40% | 39 | 35% | 1,23 (0,8-2,1) | 0,28 |
| No | 31 | 60% | 71 | 65% | ||
| Depression | ||||||
| Yes | 17 | 33% | 20 | 18% | 2,18 (1,4-5,1) | 0,036 |
| No | 35 | 67% | 90 | 82% | ||
| Comorbidity | ||||||
| Yes | 15 | 29% | 17 | 16% | 2,21 (1,3-4,9) | 0,027 |
| No | 37 | 71% | 93 | 84% | ||
DISCUSSION
Our study aimed to evaluate the factors associated with poor adherence to HAART in HIV-infected patients. We found that poor adherence to HAART (PA-HAART) was 32%, with a mean age of 45.8 ± 8.3 years for individuals with poor adherence and 44.6 ± 7.3 years for those with good adherence. Male gender was more frequent in both groups (67% vs. 63%, p-value: 0.68). Previous studies have shown that HAART adherence is variable
26
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26. Quirós-Roldan E, Magro P, Carriero C, Chiesa A, El Hamad I, Tratta E, et al. Consequences of the COVID-19 pandemic on the continuum of care in a cohort of people living with HIV followed in a single center of Northern Italy. AIDS Res Ther. 2020; 17(1): 59. DOI: https://doi.org/10.1186/s12981-020-00314-y.
27
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27.Varela M, Galdames S. Depresión y adhesión a terapia anti-retroviral en pacientes con infección por VIH atendidos en el Hospital San Pablo de Coquimbo, Chile. Rev. chil. infectol. 2014; 31(3): 323-8. DOI: http://dx.doi.org/10.4067/S0716-10182014000300011.
. In Italy, there was a decline of up to 33.6% in antiretroviral adherence when comparing the pre-pandemic period of 2019 to 2020, with a higher occurrence in females
26
➤
26.Quirós-Roldan E, Magro P, Carriero C, Chiesa A, El Hamad I, Tratta E, et al. Consequences of the COVID-19 pandemic on the continuum of care in a cohort of people living with HIV followed in a single center of Northern Italy. AIDS Res Ther. 2020; 17(1): 59. DOI: https://doi.org/10.1186/s12981-020-00314-y.
. In Chile
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27. Varela M, Galdames S. Depresión y adhesión a terapia anti-retroviral en pacientes con infección por VIH atendidos en el Hospital San Pablo de Coquimbo, Chile. Rev. chil. infectol. 2014; 31(3): 323-8. DOI: http://dx.doi.org/10.4067/S0716-10182014000300011.
, reported non-adherence rates to HAART reached up to 68%, while in Ecuador
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28. Jurado FD. Factores asociados a adherencia en pacientes con VIH/SIDA, de la unidad de atención integral de personas viviendo con VIH del Hospital General Enrique Garcés, Quito-Ecuador, julio a octubre 2014. [Tesis]. Pontificia Universidad Católica del Ecuador. Quito, Ecuador. 2015. [Accesado el 06 de Abril de 2023]. Available in: https://repositorio.puce.edu.ec/items/0ecb8ad7-a5b3-40a0-a533-7f737fbd3828.
,the figures ranged between 49.1% and 55.9%.
A recent systematic review and meta-analysis reported an optimal HAART adherence rate of 77%
17
➤
17. Chakraborty A, Hershow RC, Qato DM, Stayner L, Dworkin MS. Adherence to antiretroviral therapy among HIV patients in India: a systematic review and meta-analysis. AIDS Behav. 2020; 24(7): 2130-48. DOI: https://doi.org/10.1007/s10461-020-02779-4.
. In Peru, 17.1% of HIV (+) patients were found to be non-adherent to HAART, with male gender and comorbidities related to HIV/AIDS being identified as associated factors
22
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22. Barrera-Espinoza RW, Gómez-Gonzales WE, Girón-Vargas A, Arana-Escobar M, Nieva-Villegas LM, Gamarra-Bustillos C, et al. Factores asociados a la no adherencia al tratamiento antirretroviral en personas con VIH/SIDA. Horiz Med 2021; 21(4): e1498. DOI: https://doi.org/10.24265/horizmed.2021.v21n4.09.
. Regarding age, most studies have been consistent with our findings, indicating a trend toward earlier progression of HIV infection
15
➤
15. SeyedAlinaghi S, Mirzapour P, Pashaei Z, Afzalian A, Tantuoyir MM, Salmani R, et al. The impacts of COVID-19 pandemic on service delivery and treatment outcomes in people living with HIV: a systematic review. AIDS Res Ther. 2023; 20(1): 4. DOI: https://doi.org/10.1186/s12981-022-00496-7.
,
17
➤
17.Chakraborty A, Hershow RC, Qato DM, Stayner L, Dworkin MS. Adherence to antiretroviral therapy among HIV patients in India: a systematic review and meta-analysis. AIDS Behav. 2020; 24(7): 2130-48. DOI: https://doi.org/10.1007/s10461-020-02779-4.
,
22
➤
22. Barrera-Espinoza RW, Gómez-Gonzales WE, Girón-Vargas A, Arana-Escobar M, Nieva-Villegas LM, Gamarra-Bustillos C, et al. Factores asociados a la no adherencia al tratamiento antirretroviral en personas con VIH/SIDA. Horiz Med 2021; 21(4): e1498. DOI: https://doi.org/10.24265/horizmed.2021.v21n4.09.
.
Of the factors evaluated, living alone and personal and family history of COVID-19 were associated with poor HAART adherence, highlighting the pandemic’s impact on healthcare for HIV patients from various perspectives
5
➤
5. Cooper TJ, Woodward BL, Alom S, Harky A. Coronavirus disease 2019 (COVID-19) outcomes in HIV/AIDS patients: a systematic review. HIV Med. 2020; 21(9):567-577. DOI: https://doi.org/10.1111/hiv.12911.
,
6
➤
6. Mirzaei H, McFarland W, Karamouzian M, Sharifi H. COVID-19 among people living with HIV: a systematic review. AIDS Behav. 2021; 25(1):85-92. DOI: https://doi.org/10.1007/s10461-020-02983-2.
,
7
➤
7. Paredes JL, Navarro R, Cabrera DM, Diaz MM, Mejía F, Caceres CF. Los desafíos en la continuidad de atención de personas viviendo con VIH en el Perú durante la pandemia de la COVID-19. Rev Peru Med Exp Salud Publica. 2021; 38(1):166-70. DOI: https://doi.org/10.17843/rpmesp.2021.381.6471.
. In countries with fragile healthcare systems, such as Uganda
29
➤
29. Linnemayr S, Jennings Mayo-Wilson L, Saya U, Wagner Z, MacCarthy S, Walukaga S, et al. HIV care experiences during the COVID-19 pandemic: mixed-methods telephone interviews with clinic-enrolled HIV-infected adults in Uganda. AIDS Behav. 2021; 25(1): 28–39. DOI: http://dx.doi.org/10.1007/s10461-020-03032-8.
and sub-Saharan Africa
30
➤
30. Jewell BL, Mudimu E, Stover J, Ten Brink D, Phillips AN, Smith JA, et al. Potential effects of disruption to HIV programmes in sub-Saharan Africa caused by COVID-19: results from multiple mathematical models. Lancet HIV. 2020; 7(9): e629–40. DOI: https://doi.org/10.1016/S2352-3018(20)30211-3.
, similar effects were observed, emphasizing the impact of high perceived risk of SARS-CoV-2 infection on hospital visits, which resulted in reduced adherence to HAART.
22. Barrera-Espinoza RW, Gómez-Gonzales WE, Girón-Vargas A, Arana-Escobar M, Nieva-Villegas LM, Gamarra-Bustillos C, et al. Factores asociados a la no adherencia al tratamiento antirretroviral en personas con VIH/SIDA. Horiz Med 2021; 21(4): e1498. DOI: https://doi.org/10.24265/horizmed.2021.v21n4.09. , in a multivariate analysis, indicated that male gender and HIV-related comorbidities were associated with non-adherence to HAART, which could be attributed to a greater sense of responsibility among women 31 ➤
31.Urizar CA, Jarolin-Montiel M, Ayala-Servin N, Centurión-Wenninge C, Montiel-Garcete D. Factores asociados a la no adhrencia del tratamiento antirretroviral en pacientes con VIH en un hospital de Paraguay. Rev Cient Cienc Méd. 2020; 23(2): 166-74. DOI: https://doi.org/10.51581/rccm.v23i2.287. . In Colombia, it was found that the most common comorbidities in HIV patients were hypertriglyceridemia, prediabetes, and sexually transmitted infections, leading to increased medication use. This could cause confusion, disorganization, forgetfulness, and abandonment of therapies 32 ➤
32. Díaz-Agudelo TC. Comorbilidad de pacientes que viven con VIH y pertenecen al programa de atención integral de una IPS de Bucaramanga. [Tesis]. Universidad de Santander UDES. Bucaramanga, Colombia. 2019. [Accesado el 06 de Abril de 2023]. Available in: https://repositorio.udes.edu.co/entities/publication/307d49a2-4bca-42f5-b900-5e7395901a8d. . Situations such as unemployment, comorbidities, and the occurrence of adverse reactions promote polypharmacy, which affects treatment adherence 33 ➤
33. Jiménez-Pérez M, Caballero-Cruz G, Góngora-Valdés J, Iglesias-Sordo G, Galardy-Díaz J. Polifarmacia y adherencia farmacológica en adultos del Policlínico Docente “Louis Pasteur”. Univ Méd Pinareña. 2021; 17(2): e658. [Accesado el 06 de Abril de 2023]. Available in: https://revgaleno.sld.cu/index.php/ump/article/view/730. , 34 ➤
34. Rivera YS. La polifarmacia y su relación con la adherencia al tratamiento en pacientes ambulatorios con diabetes tipo 2 en el Servicio de Endocrinología del Hospital Sergio Enrique Bernales. [Tesis]. Universidad Inca Garcilaso de la Vega. Lima, Perú. 2017. [Accesado el 06 de Abril de 2023]. Available in: https://www.semanticscholar.org/paper/La-polifarmacia-y-su-relaci%C3%B3n-con-la-adherencia-al-Jaimes-Lisbeth/674053d809f9d09e62c207d447e819054467e790 , especially in HIV (+) patients over the age of 50 35 ➤
35.Fernández CS and Ortega VL. Polypharmacy among HIV infected people aged 50 years or older. Colomb Med (Cali). 2019; 50(3): 142-52. DOI: http://dx.org/1025100/cm.v50i3.4128. , 36 ➤
36. Gimeno-Gracia M, Sánchez-Rubio-Ferrández J, Robustillo-Cortés MA, Morillo-Verdugo R. Prevalencia de polifarmacia y complejidad farmacoterapéutica en personas mayores con VIH en España. Estudio POINT. Farm Hosp. 2020; 44(4): 127-34. DOI: https://dx.doi.org/10.7399/fh.11367. . HAART is the gold standard in the management of HIV infection; however, its immunological and clinical response is influenced by various factors. Treatment adherence is the cornerstone of its efficacy and, at the same time, a dynamic and difficult-to-assess factor 9 ➤
9. Marti M, Zürcher K, Enane LA, Diero L, Marcy O, Tiendrebeogo T, et al; IeDEA global consortium. Impact of the COVID-19 pandemic on TB services at ART programmes in low- and middle-income countries: a multi-cohort survey. J Int AIDS Soc. 2022; 25(10): e26018. DOI: https://doi.org/10.1002/jia2.26018. , 11 ➤
11. Boyd MA, Boffito M, Castagna A, Estrada V. Rapid initiation of antiretroviral therapy at HIV diagnosis: definition, process, knowledge gaps. HIV Med. 2019; 20 Suppl 1:3-11. DOI: https://doi.org/10.1111/hiv.12708. , 12 ➤
12. Abdulrahman SA, Ganasegeran K, Rampal L, Martins OF. HIV treatment adherence - a shared burden for patients, health-care providers, and other stakeholders. AIDS Rev. 2019;21(1):28-39. DOI: https://doi.org/10.24875/AIDSRev.19000037. , 13 ➤
13.Rogers A, Brazier E, Dzudie A, Adedimeji A, Yotebieng M, Muhoza B, et al. COVID-19 associated changes in HIV service delivery over time in Central Africa: results from facility surveys during the first and second waves of the pandemic. PLoS One. 2022; 17(11): e0275429. DOI: https://doi.org/10.1371/journal.pone.0275429. . The global interaction between HIV/AIDS and the COVID-19 pandemic has affected HAART adherence; social immobility and fear of SARS-CoV-2 infection diminished attendance at healthcare facilities, causing mental health disturbances, family structure changes, and altered attitudes towards medication and healthcare 2 ➤
2. Palacios M, Santos E, Velásquez MA, León M. COVID-19, una emergencia de salud pública mundial. Rev Clin Esp. 2021; 221(1): 55-61. DOI: https://doi.org/10.1016/j.rce.2020.03.001. , 5 ➤
5. Cooper TJ, Woodward BL, Alom S, Harky A. Coronavirus disease 2019 (COVID-19) outcomes in HIV/AIDS patients: a systematic review. HIV Med. 2020; 21(9):567-577. DOI: https://doi.org/10.1111/hiv.12911. , 6 ➤
6.Mirzaei H, McFarland W, Karamouzian M, Sharifi H. COVID-19 among people living with HIV: a systematic review. AIDS Behav. 2021; 25(1):85-92. DOI: https://doi.org/10.1007/s10461-020-02983-2. , 7 ➤
7.Paredes JL, Navarro R, Cabrera DM, Diaz MM, Mejía F, Caceres CF. Los desafíos en la continuidad de atención de personas viviendo con VIH en el Perú durante la pandemia de la COVID-19. Rev Peru Med Exp Salud Publica. 2021; 38(1):166-70. DOI: https://doi.org/10.17843/rpmesp.2021.381.6471. , 8 ➤
8.Posada-Vergara MP, Alzate-Ángel JC, Martínez-Buitrago E. COVID-19 and VIH. Colomb Med (Cali). 2020; 51(2): e4327. DOI: https://doi.org/10.25100/cm.v51i2.4327. . herefore, during the COVID-19 pandemic, the primary priority for governments, donors, providers, and communities should be to maintain an uninterrupted supply of HAART for people with HIV to avoid additional deaths. Likewise, the provision of other preventive measures is also important to avoid an increase in HIV incidence.
LIMITATIONS AND STRENGTHS
he main limitations were the social restrictions imposed during the COVID-19 pandemic, which led to conducting interviews with patients via telephone. The strength of our research lies in the access to a representative sample size and a high rate of participation acceptance among selected individuals.
CONCLUSIONS
In HIV-infected patients, living alone, a personal history of COVID-19, a close family member’s history of COVID-19, depression, and comorbidities are factors associated with poor adherence to HAART.
Additional Information
Funding: Self-funded. Conflict of interest statement: There are no conflicts of interest. Received: July 02, 2023 Approved: September 19, 2024
Author Correspondence Data
Correspondence author: David R. Rodríguez-Díaz E-mail: razamedica@gmail.com
Artículo publicado por la Revista de la Facultad de Medicina Humana de la Universidad Ricardo Palma. Es un artículo de acceso abierto, distribuido bajo los términos de la Licencia Creative Commons: Creative Commons Attribution 4.0 International, CC BY 4.0 , que permite el uso no comercial, distribución y reproducción en cualquier medio, siempre que la obra original sea debidamente citada. Para uso comercial, por favor póngase en contacto con revista.medicina@urp.edu.pe.
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