title: The influence of depressive symptoms and substance use on adherence to antiretroviral therapy. A cross-sectional prevalence study.
abstract: OBJECTIVE
  Adherence to antiretroviral treatment (ART) is not a stable condition, but is dynamic, like mental conditions. The aim of this study was to examine whether non-adherence to ART is related to demographic and immunological variables, substance use and presence of depressive symptoms.
  
  
  METHODS
  This was a cross-sectional prevalence study carried out at a public AIDS treatment center in the city of São Paulo, Brazil, between July 2006 and January 2007.
  
  
  METHODS
  438 patients on regular ART schedules with recent laboratory tests answered a demographic questionnaire, questions about substance use, the Hamilton Depression Rating Scale (HDRS) and the Simplified Medication Adherence Questionnaire (SMAQ).
  
  
  RESULTS
  The prevalence of non-adherence over the past three months (a pattern of treatment interruption) was 46.3%, and 27.2% also reported this in the past week (a pattern of missed doses). ART interruption was significantly related to older age, lower CD4+ cell count and homosexual/bisexual transmission. The pattern of missed doses was significantly related to younger age, higher HDRS scores and higher viral load of RNA HIV.
  
  
  CONCLUSIONS
  ART interruption may reflect recall errors and changes to the Brazilian demographic characteristics of HIV infection. The missed doses may reflect lifestyle characteristics of younger individuals. Attendance for HIV-positive individuals, particularly younger patients, should involve interventions and counseling in relation to the presence of depressive symptoms.
authors.affiliation: Universidade Anhembi Morumbi, São Paulo, Brazil.
authors.forename: Claudia Siqueira
authors.initials: CS
authors.lastname: Tufano
authors.affiliation: Universidade de São Paulo (USP), São Paulo, Brazil.
authors.forename: Ricardo Abrantes do
authors.initials: RA
authors.lastname: Amaral
authors.affiliation: Universidade de São Paulo (USP), São Paulo, Brazil.
authors.forename: Luciana Roberta Donola
authors.initials: LR
authors.lastname: Cardoso
authors.affiliation: Universidade de São Paulo (USP), São Paulo, Brazil.
authors.forename: André
authors.initials: A
authors.lastname: Malbergier
mesh_terms: D000328:Adult; D000367:Age Factors; D023241:Antiretroviral Therapy, Highly Active / Q000523:psychology* / Q000706:statistics & numerical data; D001938:Brazil / Q000453:epidemiology; D003430:Cross-Sectional Studies; D003863:Depression / Q000453:epidemiology / Q000523:psychology*; D005260:Female; D015658:HIV Infections / Q000188:drug therapy; D006801:Humans; D016015:Logistic Models; D008297:Male; D055118:Medication Adherence / Q000523:psychology*; D008875:Middle Aged; D012737:Sex Factors; D012959:Socioeconomic Factors; D019966:Substance-Related Disorders / Q000453:epidemiology / Q000523:psychology*; D011795:Surveys and Questionnaires; D013997:Time Factors; D016903:Drug Monitoring