Cardiovascular medication adherence testing in patients living with HIV: A single-centre observational study

IF 2.8 3区医学 Q2 INFECTIOUS DISEASES

HIV Medicine Pub Date : 2024-09-24 DOI:10.1111/hiv.13715

Joshua Nazareth, Ayobami Adebayo, Muhammad Fahad, Hanfa Karim, Daniel Pan, Shirley Sze, Christopher A. Martin, Jatinder S. Minhas, Dennis Bernieh, Hanad Osman, Phayre Elverstone, Iain Stephenson, Pankaj Gupta, Manish Pareek

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引用次数: 0

Abstract

Introduction

People with HIV (PWH) are at an increased risk of developing cardiovascular disease (CVD) compared to HIV-negative individuals. We sought to evaluate the adherence to medications for CVD in PWH and identify factors associated with non-adherence to these medications.

Methods

We conducted a cross-sectional study at the University Hospitals of Leicester NHS Trust between 16 April 2019 and 8 November 2022. We recruited consecutive PWH, who were attending a routine follow-up outpatient appointment and were prescribed at least one medication for CVD. In addition, we included urinary adherence results of patients with samples collected as part of routine clinical care. We used liquid chromatography–tandem mass spectrometry (LC–MS/MS) to assess if their prescribed medications (antihypertensives, diuretics, beta-blockers, lipid-lowering agents, antiplatelets, anticoagulants, antidiabetic medications) were present in the participant's urine sample. Multivariable models were used to identify demographic or clinical features that were associated with non-adherence.

Results

A total of 162 PWH were included in the analysis. Median age was 55 [interquartile range (IQR): 50–61] years, 63% were male, average time living with HIV was 15 years (IQR: 11–19) and the majority (98%) had an undetectable HIV viral load. In approximately one-third of patients (59/162), at least one prescribed medication of interest was not detected in urine. Non-adherence to lipid-lowering agents was common (35/88, 40%). On multivariable logistic regression, the number of prescribed cardiovascular medications, was associated with medication non-adherence [medication non-adherence, per one medication increase: adjusted odds ratio (95% confidence interval) = 1.78 (1.34–2.36); p < 0.001].

Conclusion

We found sub-optimal adherence to medications for CVD in PWH. In order to maximize the clinical benefit of statin therapy in PWH, factors requiring consideration include: improved medication adherence, awareness of polypharmacy, educational interventions and quantitative assessment of sub-optimal adherence through chemical adherence testing.

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艾滋病病毒感染者心血管用药依从性检测：单中心观察研究。

导言：与艾滋病毒阴性者相比，艾滋病毒感染者（PWH）罹患心血管疾病（CVD）的风险更高。我们试图评估 PWH 对心血管疾病药物治疗的依从性，并确定与不依从这些药物治疗相关的因素：我们于 2019 年 4 月 16 日至 2022 年 11 月 8 日在莱斯特大学医院 NHS 信托基金会开展了一项横断面研究。我们招募了参加常规门诊随访的连续就诊的心血管疾病患者，他们至少服用了一种治疗心血管疾病的药物。此外，我们还纳入了在常规临床护理过程中采集样本的患者的尿液依从性结果。我们使用液相色谱-串联质谱法（LC-MS/MS）来评估参与者的尿样中是否含有处方药物（降压药、利尿药、β-受体阻滞剂、降脂药、抗血小板药、抗凝药、抗糖尿病药）。多变量模型用于确定与不依从性相关的人口统计学或临床特征：共有 162 名 PWH 纳入分析。中位年龄为 55 岁[四分位数间距（IQR）：50-61]，63% 为男性，感染 HIV 的平均时间为 15 年（IQR：11-19），大多数患者（98%）的 HIV 病毒载量检测不到。约有三分之一的患者（59/162）在尿液中检测不到至少一种处方药。不坚持服用降脂药的情况很普遍（35/88，40%）。在多变量逻辑回归中，处方心血管药物的数量与不遵医嘱用药有关[不遵医嘱用药，每增加一种药物：调整后的几率比（95% 置信区间）= 1.78 (1.34-2.36); p 结论：我们发现威利什病患者对心血管疾病药物治疗的依从性并不理想。为了最大限度地提高他汀类药物治疗在威利什病患者中的临床疗效，需要考虑的因素包括：提高用药依从性、对多重用药的认识、教育干预以及通过化学依从性测试对次优依从性进行定量评估。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

HIV Medicine 医学-传染病学

CiteScore

5.10

自引率

10.00%

发文量

167

审稿时长

6-12 weeks

期刊介绍： HIV Medicine aims to provide an alternative outlet for publication of international research papers in the field of HIV Medicine, embracing clinical, pharmocological, epidemiological, ethical, preclinical and in vitro studies. In addition, the journal will commission reviews and other feature articles. It will focus on evidence-based medicine as the mainstay of successful management of HIV and AIDS. The journal is specifically aimed at researchers and clinicians with responsibility for treating HIV seropositive patients.