Influencia del consumo de sustancias y el deterioro cognitivo en la adherencia al tratamiento antirretroviral en pacientes VIH+ Influence of substance use and cognitive impairment on adherence to antiretroviral therapy in HIV+ patients

Autores/as

  • Irene Sánchez-Rivero Hospital Universitario Ramón y Cajal
  • Agustín Madoz-Gúrpide Hospital Universitario Ramón y Cajal. Universidad de Alcalá
  • Carlos Parro-Torres Hospital General Universitario Gregorio Marañón
  • Daniel Hernández-Huerta Hospital Universitario Ramón y Cajal
  • Enriqueta Ochoa Mangado Hospital Universitario Ramón y Cajal. Universidad de Alcalá

DOI:

https://doi.org/10.20882/adicciones.1025

Palabras clave:

VIH, Tratamiento antirretroviral, Adherencia terapéutica, Deterioro cognitivo, Consumo de sustancias. HIV, Antiretroviral therapy, Medication adherence, Cognitive dysfunction, Substance use.

Resumen

La adherencia estricta al tratamiento antirretroviral (TAR) es imprescindible para que este sea eficaz en la disminución de la morbimortalidad asociada al VIH. Se ha sugerido que el consumo de sustancias y el deterioro cognitivo constituyen factores de riesgo para una mala adherencia. En este sentido, el objetivo de este estudio es evaluar cuál es la influencia sobre la adherencia al TAR de la disfunción cognitiva, así como del consumo de determinadas sustancias (alcohol, heroína, cocaína, otros estimulantes, cannabis y benzodizepinas) y/o el tratamiento con metadona, en el marco concreto de una población española de referencia. Se realizó un estudio observacional tipo casos y controles con una muestra de 125 pacientes VIH+, que se dividieron en sujetos malos adherentes (casos) y buenos adherentes al TAR (controles). La adherencia se evaluó mediante el reporte de Farmacia Hospitalaria, contrastada con la escala Simplified Medication Adherence Questionnaire (SMAQ) y la opinión del profesional médico de referencia. La función cognitiva fue evaluada con el Test del Mapa del Zoo y el Trail Making Test (TMT), y el consumo de sustancias, mediante un protocolo de historia clínica semi-estructurada. El análisis estadístico se realizó mediante regresión logística binaria. Los resultados mostraron que el abuso de alcohol y el deterioro en la función cognitiva ejecutiva, medida por el Test del Mapa del Zoo, constituyen factores de riesgo independientes para una mala adherencia. No se ha demostrado relación de la adherencia al TAR con el consumo de otras sustancias ni con la puntuación obtenida en el TMT. La detección de deterioro cognitivo mediante el Test del Mapa del Zoo, así como del consumo de alcohol, podrían ayudar a desarrollar estrategias de mejora del cumplimiento terapéutico en pacientes VIH+.
Strict adherence to antiretroviral treatment (ART) is needed to ensure the effectiveness of HIV treatment. The adverse effects of substance abuse and neurocognitive impairment on medication adherence have both been suggested by several studies. Therefore, the aim of this research is to study the relationship among adherence to ART, cognitive dysfunction, and abuse of certain substances (alcohol, heroin, cocaine, other stimulants, cannabis and benzodiazepines) and/or methadone treatment in our social environment. We performed an observational case-control study with a sample of 125 HIV+ patients, who were classified as patients with poor adherence (cases) and subjects with adequate compliance (controls). Adherence was defined by the Hospital Pharmacy and verified with the Simplified Medication Adherence Questionnaire (SMAQ) and the reference physician’s clinical impression. Cognitive functioning was measured with the Zoo Map Test and Trail Making Test (TMT). Substance abuse was collected through a semi-structured clinical interview protocol. Statistical analysis was made using a binary logistic regression model. The results indicate that both alcohol abuse and neurocognitive impairment measured by Zoo Map Test were significantly associated with poorer adherence to ART. No significant association was found between adherence and other substance use, or between adherence and TMT score. Screening of cognitive impairment measured by the Zoo Map Test and alcohol abuse may lead to the development of strategies to improve de adherence to ART in HIV+ patients.

Biografía del autor/a

Irene Sánchez-Rivero, Hospital Universitario Ramón y Cajal

Servicio de Psiquiatría. Hospital Universitario Ramón y Cajal, Madrid. Spain

Agustín Madoz-Gúrpide, Hospital Universitario Ramón y Cajal. Universidad de Alcalá

Centro de Salud Mental San Blas, Servicio de Psiquiatría, Hospital Universitario Ramón y Cajal (IRYCIS). Universidad de Alcalá, Madrid. Spain

Carlos Parro-Torres, Hospital General Universitario Gregorio Marañón

Servicio de Psiquiatría. Hospital General Universitario Gregorio Marañón, Madrid. Spain

Daniel Hernández-Huerta, Hospital Universitario Ramón y Cajal

Servicio de Psiquiatría. Hospital Universitario Ramón y Cajal, Madrid. Spain

Enriqueta Ochoa Mangado, Hospital Universitario Ramón y Cajal. Universidad de Alcalá

Servicio de Psiquiatría, Hospital Universitario Ramón y Cajal (IRYCIS). Universidad de Alcalá, Madrid. Spain

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Publicado

2018-11-21

Número

Vol. 32 Núm. 1 (2020)

Sección

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