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Психологическое состояние и приверженность к лечению ВИЧ

Психологическое состояние и приверженность к лечению ВИЧ

Психологическое состояние пациентов отражается на их приверженности к АРТ, принимаемой с целью профилактики

«Позитивное психологическое состояние пациентов было единственным значимым фактором, способствующим оптимальному уровню их приверженности к АРТ, принимаемой с целью профилактики ВИЧ-инфекции, передаваемой половым путем…» — отмечается в отчете исследования «HPTN 052». В 2011 году, результаты этого исследования показали, что в серодискордантных парах прием АРТ ВИЧ-положительным партнером снижал риск передачи инфекции на 96%. Участники исследования проходили регулярные консультации по приверженности и безопасному сексу. Уровень приверженности оценивался при каждой посещении центра методом учета оставшихся у пациента доз препаратов, а также методом самооценки пациентов. Участникам также задавались вопросы об уровне социальной поддержки и возможных причинах, приводящих к пропуску приема лекарственных препаратов.

82% участников приняли все или почти все выданные им дозы препаратов. Несмотря на то, что целый ряд факторов оказывал влияние на приверженность пациентов к терапии, единственным независимым фактором, связанным с высоким уровнем приверженности, стало хорошее психологическое состояние пациентов. В то же время, единственным достоверным фактором, влияющим на уровень вирусологического контроля, является высокий, по крайней мере, 95%-уровень приверженности.

Результат другого исследования, проведённого в Кении, показал 36% уровень несостоятельности терапии при назначении препаратов первого выбора и 36% уровень (13% из общего числа участников) несостоятельности препаратов второго выбора, что, в условиях ограниченных ресурсов, оставляло в резерве для лечения пациентов всего несколько схем терапии. Выявленный уровень несостоятельности терапии оказался значительно выше по сравнению с зажиточными странами. Использование неадекватных режимов терапии и отсутствие консультативной поддержки в отношении приверженности приводят к неуспешным попыткам в достижении вирусологического контроля над инфекцией.

Комментарий AIDSmap.com: Последующее исследование «HPTN 052» представляет собой один из примеров, подтверждающих, что неблагоприятное психологическое состояние пациентов является наиболее значимым прогностическим фактором низкого уровня их приверженности к терапии. Эти результаты являются бесценным напоминание о том, что без одновременного осуществления социальной и психологической поддержки ВИЧ-инфицированных людей, антиретровирусная терапия сама по себе не сможет полностью осуществить свой потенциал в снижении уровня заболеваемости ВИЧ-инфекцией. Второе исследование также выявляет значительную ассоциацию между низким уровнем приверженности пациентов к лечению и использованием, своего рода, дешёвых, устаревших и высокотоксичных схем терапии. В частности, использование ставудина (d4T) было связано с 41% уровнем несостоятельности АРТ. Хотя, даже в этом исследовании, средний уровень вирусной нагрузки среди пациентов, активно участвующих в программах общественной поддержки «равный-равному», был почти в 20 раз ниже, чем среди лиц, не получавших такую поддержку.

Психологическое состояние и приверженность к лечению ВИЧ

www.parniplus.ru

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149 Comments

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