Relación entre la adherencia al tratamiento antirretroviral en pacientes VIH+ y el consumo de alcohol, asociado o no al uso de otras sustancias Relationship between alcohol consumption, whether linked to other substance use or not, and antiretroviral treatment adherence in HIV+ patients

Autores/as

  • Sara González-Álvarez Servicio de Psiquiatría, Hospital Universitario Ramón y Cajal. Madrid
  • Agustín Madoz-Gúrpide Centro de Salud Mental San Blas. Servicio de Psiquiatría, Hospital Universitario Ramón y Cajal (IRYCIS). Universidad de Alcalá. Madrid
  • Carlos Parro-Torres Servicio de Psiquiatría, Hospital General Universitario Gregorio Marañón. Madrid
  • Daniel Hernández-Huerta Servicio de Psiquiatría, Hospital Universitario Ramón y Cajal. Madrid
  • Enriqueta Ochoa Mangado Servicio de Psiquiatría, Hospital Universitario Ramón y Cajal (IRYCIS). Universidad de Alcalá. Madrid

DOI:

https://doi.org/10.20882/adicciones.916

Palabras clave:

VIH, Terapia antirretroviral (TARGA), Adherencia terapéutica, Trastorno por uso de alcohol, Policonsumo. HIV, Highly Active Antiretroviral Therapy (HAART), Medication adherence, Alcohol use, Substance use.

Resumen

El consumo perjudicial de alcohol es un diagnóstico de elevada prevalencia en pacientes VIH+. Distintos estudios han destacado la influencia negativa del mismo sobre la adherencia al tratamiento antirretroviral, aunque pocos de ellos valoran además el consumo de otras sustancias. En España, el consumo de alcohol se presenta frecuentemente en situación de policonsumo, fundamentalmente de cannabis y cocaína. El objetivo es comprobar cómo influye el consumo de alcohol, asociado o no al uso de otras sustancias (cocaína, heroína, metadona y/o cannabis), en la adherencia al tratamiento antirretroviral en nuestro entorno. Se ha realizado un estudio observacional tipo casos y controles sobre una muestra de 119 individuos VIH+. Conforman los casos (n=40) sujetos no adherentes al tratamiento farmacológico según reporte de Farmacia Hospitalaria, corroborado por el Simplified Medication Adherence Questionnaire (SMAQ) y la opinión del profesional de referencia. Se consideran controles (n=79) una muestra de pacientes de características similares con buena adherencia terapéutica según los mismos métodos de valoración. La recogida de datos se hizo entre mayo 2013 y septiembre 2015. El análisis estadístico se realizó mediante regresión logística binaria. Los resultados muestran que el consumo de alcohol empeora la adherencia al tratamiento antirretroviral. El uso de metadona supone un incremento estadísticamente significativo del riesgo de no adherencia. No se han encontrado diferencias significativas entre los grupos del estudio respecto a los consumos de cocaína, heroína o cannabis. Por tanto, la detección del consumo de sustancias, especialmente de alcohol, y su abordaje en pacientes VIH+ puede repercutir positivamente en el cumplimiento terapéutico, en beneficio de una mayor efectividad de la terapia antirretroviral.
Hazardous alcohol consumption is a common diagnosis among people living with HIV infection. The relationship between alcohol consumption and poor adherence to antiretroviral therapy has been highlighted in different studies, yet few of them performed a parallel analysis of other substance use. In Spain, alcohol consumption is frequently associated with other substance use, mainly cannabis and cocaine. The aim of this study is to assess the influence of hazardous alcohol consumption both combined with other substances (cocaine, heroin, methadone and/or cannabis) or alone on antiretroviral therapy adherence in our social environment. We performed an observational case-control study including 119 HIV+ individuals. We recruited 40 non-adherent patients, defined by less than 90% compliance according to hospital pharmacy refill data, and corroborated by the Simplified Medication Adherence Questionnaire (SMAQ) and referring professional’s opinion. Control cases (n=79) were defined as those patients with similar characteristics but considered adherent according to the same parameters. Data collection took place between May 2013 and September 2015. Statistical analysis was performed using a binary logistic regression model. Our results indicate that alcohol consumption decreases adherence to antiretroviral therapy. The use of methadone represents a statistically significant increased risk of poor adherence. No significant differences were found between adherent and non-adherent groups regarding cocaine, heroin or cannabis use in this study. In summary, the detection of substance use and especially alcohol consumption in HIV+ patients can improve the effectiveness of antiretroviral therapy by identifying and treating at-risk individuals for a poor therapeutic adherence.

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Publicado

2017-07-14

Número

Vol. 31 Núm. 1 (2019)

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