A cross-sectional study was conducted on HIV-infected adults being treated with antiretroviral drugs at a reference service in Southern Brazil. Participants answered a sociodemographic questionnaire and were tested by scales assessing sociocognitive variables. Adherence to treatment was assessed by a self-report inventory developed for the study. Clinical information was obtained from the patients' records. Significance tests were conducted using univariate logistic regressions followed by multivariate logistic regression analysis. A total of 195 patients participated in the study and 56.9% of them reported > or = 95% adherence on the previous two days. In univariate analysis, the odds of adherence increased with self-efficacy (a person's conviction that he/she can successfully execute the behavior required to produce a certain desired outcome) in taking medications as prescribed (OR = 3.50, 95% CI 1.90-6.55), and decreased with perception of negative affect and physical concerns (OR = 0.71, 95% CI 0.53-0.95). The odds were lower for taking antiretroviral medications >4 times a day (OR = 0.44, 95% CI 0.20-0.94) and higher for patients with 8 years of schooling (OR = 2.28, 95% CI 1.12-4.66). In the multivariate analysis, self-efficacy (OR = 3.33, 95% CI 1.69-6.56) and taking medication >4 times a day (OR = 0.34, 95% CI 0.14-0.80) were independently associated with adherence. Self-efficacy was the most important predictor of adherence, followed by number of times antiretroviral medication was taken per day. Among sociodemographic and clinical variables, only the number of years of schooling was associated with adherence. Motivational interventions based on self-efficacy may be useful for increasing treatment adherence.

Neurocognitive impairment (NCI) is frequently observed in patients infected with human immunodeficiency virus (HIV) and results from the compromise of subcortical brain structures by the virus. The manifestations of NCI range from asymptomatic impairment to dementia. In addition to cognitive impairment resulting from HIV infection, other factors such as depression are associated with the loss of cognitive functions. The aim of this study was to estimate the prevalence of NCI in HIV-positive patients in a city in southern Brazil and to establish possible associations for the prevalence of NCI with HIV-related and other risk factors. This cross-sectional study of HIV-positive outpatients was conducted in a specialized care service in the city of Pelotas in Southern Brazil. Sociodemographic data and HIV-related information were collected, and all patients underwent psychiatric and neurocognitive evaluations. The prevalence of NCI among the 392 patients was 54.1% when tracked using the IHDS (International HIV Dementia Scale) and 36.2% when the IHDS was associated with a battery of complementary tests. A bivariate analysis suggested an association of NCI with gender, age, educational level, depression, current CD4 count and lowest CD4 count. The association of NCI with depression remained in the Poisson regression (PR=1.96, 95%CI=1.12-3.42). The prevalence of cognitive impairment in HIV-positive patients estimated in this study is in accordance with international and Brazilian data. Of the factors analyzed, depression showed the greatest evidence of association with neurocognitive loss. Based on our findings, the inclusion of instruments to evaluate depression in our services for patients with HIV and acquired immunodeficiency syndrome (AIDS) is recommended.

This study evaluated the impact of 9 single nucleotide polymorphisms (SNPs) in 6 candidate genes (APOB, APOA5, APOE, APOC3, SCAP, and LDLR) over dyslipidemia in HIV-infected patients on stable antiretroviral therapy (ART) with undetectable viral loads. Blood samples were collected from 614 patients at reference services in the cities of Porto Alegre, Pelotas, and Rio Grande in Brazil. The SNPs were genotyped by conventional polymerase chain reaction (PCR) and real-time PCR. The prevalence of dyslipidemia was particularly high among the protease inhibitors-treated patients (79%). APOE (rs429358 and rs7412) genotypes and APOA5 −1131T>C (rs662799) were associated with plasma triglycerides (TG) and low-density-lipoprotein cholesterol levels (LDL-C). The APOA5 −1131T>C (rs662799) and SCAP 2386A>G (rs12487736) polymorphisms were significantly associated with high-density-lipoprotein cholesterol levels. The mean values of the total cholesterol and LDL-C levels were associated with both the APOB SP Ins/Del (rs17240441) and APOB XbaI (rs693) polymorphisms. In conclusion, our data support the importance of genetic factors in the determination of lipid levels in HIV-infected individuals. Due to the relatively high number of carriers of these risk variants, studies to verify treatment implications of genotyping before HAART initiation may be advisable to guide the selection of an appropriate antiretroviral therapy regimen.

A terapia anti-retroviral reduz a viremia plasmática (Paterson e cols., 1999) e, assim, melhora a sobrevida (Chiasson e cols., 1999; Mocroft e cols., 1998) e a qualidade de vida (Brodt e cols., 1997; Palella e cols., 1998) de pacientes com HIV/AIDS. A efetividade do tratamento parece requerer altos níveis de adesão: viremia plasmática indetectável (menor do que 500 cópias por mililitro) foi abservada em 81% dos pacientes que usavam 95% ou mais da dose prescrita; quando os níveis de adesão eram um Vera Lúcia da Silveira Universidade Católica de PelotasResumo Uma escala de expectativa de auto-eficácia para seguir prescrição anti-retroviral em situações difíceis (21 itens) foi desenvolvida pela análise do conteúdo de entrevistas com pacientes que estavam em tratamento ou que o abandonaram. A consistência interna e a validade de construto foram examinadas em 60 sujeitos que freqüentaram ambulatório para pacientes em estágios avançados da doença (hospital-dia). Um escore de expectativa de auto-eficácia para adesão ao tratamento foi derivado do primeiro componente da análise de componentes principais. A média do escore foi 0,25 para os sujeitos aderentes e -0,33 para os não-aderentes ao tratamento (teste t, p = 0,046). A chance de adesão duplicou quando o escore de expectativa de autoeficácia era maior em uma unidade (OR = 2,07; IC95% = 1,002 a 4,26). A consistência interna foi alta (alfa de Cronbach = 0.96). A escala demonstrou validade de construto e confiabilidade para medir auto-eficácia para tratamento anti-retroviral nesses pacientes. Palavras-chave: Expectativas de auto-eficácia; AIDS; HIV; adesão a tratamento; tratamento anti-retroviral.Development of a Scale of Self-Efficacy for Adherence to Antiretroviral Therapy Abstract A 21-item scale of efficacy-expectation for adhesion to antiretroviral therapy in high-risk situations was developed by content analysis of interviews with HIV/AIDS patients undergoing and dropouts from therapy. Internal consistency and construct validity were examined in 60 patients attending at an ambulatory for patients in advanced stages of the disease (day-hospital).A score of self-efficacy for treatment adhesion was derived from the first component of the principal component analysis. The mean score was 0.25 among adherent patients and 0.33 among those who were non-adherent (t test, p < 0.046). The odds of treatment adhesion increased 2,07 times when the efficacy-expectation score increased by one unit (OR = 2,07; IC95% = 1,002 a 4,26). The internal consistency was high (Cronbach-alpha = 0.96). The scale demonstrated construct validity and reliability as a measure of self-efficacy for antiretroviral therapy in these patients.