Lifestyle and adherence to antiretrovirals in people with HIV in the COVID-19 pandemic

Cunha, Gilmara Holanda da; Lima, Maria Amanda Correia; Siqueira, Larissa Rodrigues; Fontenele, Marina Soares Monteiro; Ramalho, Ane Kelly Lima; Almeida, Paulo César de

doi:10.1590/0034-7167-2021-0644

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Revista Brasileira de Enfermagem

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ORIGINAL ARTICLE • Rev. Bras. Enferm. 75 (Suppl 2) • 2022 • https://doi.org/10.1590/0034-7167-2021-0644 copy

Lifestyle and adherence to antiretrovirals in people with HIV in the COVID-19 pandemic

Estilo de vida e adesão aos antirretrovirais em pessoas com HIV na pandemia de COVID-19

Estilo de vida y adherencia a los antirretrovirales en personas con VIH en la pandemia de COVID-19

Authorship SCIMAGO INSTITUTIONS RANKINGS

ABSTRACT

Objectives:

to assess the lifestyle and adherence to antiretrovirals in people living with HIV (PLHIV) in the COVID-19 pandemic.

Methods:

a cross-sectional study, through telephone interview to 150 patients, using a sociodemographic, epidemiological and clinical form, and questionnaires to assess lifestyle profile and adherence to antiretrovirals. Statistics analysis used Fisher’s exact test, odds ratio and 95% confidence interval.

Results:

most patients had a satisfactory lifestyle (121; 80.7%) and adequate adherence to antiretrovirals (133; 88.7%). All were in social isolation, without follow-up appointments, with access to the health service only to receive antiretrovirals, and 16 (10.7%) had COVID-19 infection. Evangelicals (p=0.002), Spiritists (p=0.045), patients using atazanavir (p=0.0001) and ritonavir (p=0.002) had a more unsatisfactory lifestyle. Adherence to antiretrovirals was more inadequate in female patients (p=0.009), with two (p=0.004) and three or more children (p=0.006), retired (p=0.029), with serodiscordant partner (p=0.046) and diagnosis time of 5 to 10 years (p=0.027).

Conclusions:

the most PLHIV had a satisfactory lifestyle and adequate adherence to antiretrovirals, but some groups needed intervention to improve medication adherence and lifestyle.

Descriptors:
HIV; COVID-19; Life Style; Antiretroviral Therapy; Highly Active; Nursing

Sociodemographic variables	Individual lifestyle				Odds ratio	95% confidence interval	*p value^ * Fisher’s exact test;**
	Unsatisfactory (n=29)		Satisfactory (n=121)
	n	%	n	%
Age group
19 - 29	6	20.6	16	13.2	2.2	0.7 - 7.0	0.143
30 - 39	11	38.0	32	26.5	2.0	0.8 - 5.2	0.112
> 40	12	41.4	73	60.3	1.0
Sex
Female	12	41.4	42	34.7	1.3	0.5 - 3.0	0.503
Male	17	58.6	79	65.3	1.0
Skin color
Black	6	20.7	14	11.5	3.7	0.8 - 17.1	0.084
Brown	19	65.5	76	62.9	2.1	0.5 - 7.9	0.235
Yellow	1	3.5	5	4.1	1.7	0.1 - 20.2	0.662
White	3	10.3	26	21.5	1.0
Years of study
1 - 9	12	41.4	39	32.2	2.4	0.6 - 9.7	0.188
10 - 12	14	48.3	58	48.0	1.9	0.5 - 7.3	0.330
≥ 13	3	10.3	24	19.8	1.0
Marital status
Not married	16	55.2	65	53.8	1.1	0.4 - 2.8	0.832
Divorced	5	17.3	20	16.5	1.1	0.3 - 4.0	0.854
Married	8	27.5	36	29.7	1.0
Number of children
1	7	24.2	22	18.1	1.6	0.5 - 4.6	0.370
2	7	24.2	19	15.7	1.8	0.6 - 5.4	0.246
≥ 3	3	10.3	19	15.7	0.8	0.2 - 3.1	0.753
None	12	41.3	61	50.5	1.0
Religion
Evangelical	14	48.2	37	30.6	4.3	1.7 -11.5	0.002
Spiritist	5	17.2	8	6.6	3.8	1.1 -15.0	0.045
Catholic	10	3.4	76	62.8	1.0
Occupational situation
Employed	16	55.2	68	56.2	1.3	0.4 - 4.4	0.620
Unemployed	9	31.1	30	24.7	1.7	0.4 - 6.3	0.410
Retired	4	13.7	23	19.1	1.0
People in the home
≥ 5	2	6.8	12	10.0	0.9	0.1 - 4.7	0.940
3 - 4	16	55.2	47	38.8	1.9	0.8 - 4.5	0.134
1 - 2	11	38.0	62	51.2	1.0
Monthly family income^ In minimum wages, value in 2020: $ 201.34.
≤ 1	13	44.9	31	25.6	3.2	0.9 - 11.0	0.053
1 - 2	9	31.0	39	32.3	1.7	0.5 - 6.3	0.368
2 - 3	3	10.3	20	16.5	1.1	0.2 - 5.7	0.855
> 3	4	13.8	31	25.6	1.0

Epidemiological and clinical variables	Individual lifestyle				Odds ratio	95% confidence interval	*p value^ * Fisher’s exact test;**
	Unsatisfactory (n=29)		Satisfactory (n=121)
	n	%	n	%
Exposure category
Injecting drug user	4	13.7	6	5.0	3.0	0.8 - 11.6	0.088
Sexual	25	86.3	115	95.0	1.0
Sexual orientation
Heterosexual	19	65.5	67	55.3	3.7	0.5 - 30.0	0.197
Homosexual	9	31.0	41	33.9	2.9	0.3 - 24.7	0.327
Bisexual	1	3.5	13	10.8	1.0
Lives with partner
No	20	69.0	73	60.3	1.5	0.6 - 3.5	0.391
Yes	9	31.0	48	39.7	1.0
Time of diagnosis
< 5	9	31.0	34	28.0	1.1	0.4 - 3.2	0.795
5 ≥ 10	11	38.0	48	39.8	0.9	0.3 - 2.6	0.989
≥ 11	9	31.0	39	32.2	1.0
ART^ ART: Antiretroviral therapy. time (in years)
< 5	10	34.4	36	29.8	1.2	0.4 - 3.5	0.675
5 ≥ 10	8	27.6	36	29.8	1.0	0.3 - 2.8	0.984
≥ 11	11	38.0	49	40.4	1.0
CD4+ T lymphocytes
< 350 cells/mm³	2	6.9	12	10.0	0.6	0.1 - 3.1	0.617
> 350 cells/mm³	27	93.1	109	90.0	1.0
Viral load
Undetectable	27	93.1	112	92.6	1.0	0.2 - 5.3	0.920
Detectable	2	6.9	9	7.4	1.0
Atazanavir
Yes	11	38.0	13	10.7	5.0	1.9 - 13.0	0.0001
No	18	62.0	108	89.3	1.0
Ritonavir
Yes	11	38.0	16	13.2	4.0	1.6 - 10.0	0.002
No	18	62.0	105	86.8	1.0
Had COVID-19
No	25	86.2	109	90.0	0.6	0.2 - 2.3	0.545
Yes	4	13.8	12	10.0	1.0

Sociodemographic variables	Adherence to antiretroviral therapy				Odds ratio	95% confidence interval	*p value^ * Fisher’s exact test;**
	Inadequate (n=17)		Adequate (n=133)
	n	%	n	%
Age group
19 - 29	1	5.8	21	15.7	0.2	0.0 - 2.3	0.223
30 - 39	4	23.6	39	29.3	0.6	0.1 - 2.0	0.438
> 40	12	70.6	73	55.0	1.0
Sex
Female	11	64.8	43	32.3	3.8	1.3 - 11.0	0.009
Male	6	35.2	90	67.7	1.0
Skin color
Black	1	5.8	19	14.2	0.4	0.0 - 4.8	0.506
Brown	11	64.8	84	63.2	1.1	0.2 - 4.3	0.855
Yellow	2	11.7	4	3.0	4.3	0.5 - 34.5	0.149
White	3	17.7	26	19.6	1.0
Years of study
1 - 9	9	52.9	42	31.5	2.6	0.5 - 13.4	0.219
10 - 12	6	35.3	66	49.7	1.1	0.2 - 6.0	0.881
≥ 13	2	11.8	25	18.8	1.0
Marital status
Not married	9	52.9	72	54.1	1.7	0.4 - 6.7	0.438
Divorced	5	29.4	20	15.0	3.4	0.7 - 15.7	0.103
Married	3	17.7	41	30.9	1.0
Number of children
1	3	17.7	26	19.5	2.6	0.5 - 14.1	0.230
2	6	35.3	20	15.0	7.0	1.6 - 30.5	0.004
≥ 3	5	29.3	17	12.8	6.8	1.4 - 31.5	0.006
None	3	17.7	70	52.7	1.0
Religion
Evangelical	6	35.2	45	33.9	2.3	0.7 - 6.8	0.126
Spiritist	2	11.8	11	8.2	0.7	0.0 - 6.8	0.820
Catholic	9	53.0	77	57.9	1.0
Occupational situation
Unemployed	5	29.4	34	25.6	1.9	0.5 - 6.6	0.317
Retired	6	35.3	21	15.7	3.7	1.0 - 12.7	0.029
Employed	6	35.3	78	58.7	1.0
People in the home
1 - 2	13	76.4	60	45.1	4.3	1.1 - 15.9	0.019
3 - 4	3	17.7	60	45.1	2.8	0.3 - 23.4	0.323
≥ 5	1	5.9	13	9.8	1.0
Monthly family income^ In minimum wages, value in 2020: $ 201.34.
< 1	8	47.0	36	27.0	3.6	0.7 - 18.6	0.100
1 - 2	5	29.4	43	32.3	1.9	0.3 - 10.6	0.449
2 - 3	2	11.8	21	15.8	1.5	0.2 - 12.0	0.664
> 3	2	11.8	33	24.9	1.0

Epidemiological and clinical variables	Adherence to antiretroviral therapy				Odds ratio	95% confidence interval	*p value^ * Fisher’s exact test;**
	Inadequate (n=17)		Adequate (n=133)
	n	%	n	%
Category of exposure
Injecting drug user	3	17.7	7	5.2	3.8	0.8 - 16.7	0.055
Sexual	14	82.3	126	94.8	1.0
Sexual orientation
Heterosexual	14	82.4	72	54.1	0.8	0.7 - 0.9	0.105
Homosexual	3	17.6	47	35.3	0.9	0.8 - 1.0	0.352
Bisexual	0	0.0	14	10.6	1.0
Partner’s serology
Negative	6	100.0	35	58.3	0.8	0.7 - 0.9	0.046
Positive	0	0.0	25	41.7	1.0
Time of diagnosis
< 5	5	29.4	38	28.6	0.5	0.1 - 1.8	0.350
5 - 10	3	17.6	56	42.1	0.2	0.0 - 0.9	0.027
≥ 11	9	53.0	39	29.3	1.0
ART^ ART: Antiretroviral therapy. time (in years)
< 5	5	29.4	41	30.9	0.5	0.1 - 1.8	0.327
5 - 10	4	23.6	56	42.1	0.3	0.0 - 1.1	0.071
≥ 11	8	47.0	36	27.0	1.0
CD4+ T lymphocytes count
< 350 cells/mm³	1	5.9	13	9.8	0.5	0.0 - 4.7	0.605
> 350 cells/mm³	16	94.1	120	90.2	1.0
Viral load
Undetectable	16	94.1	123	92.5	1.3	0.1 - 10.8	0.808
Detectable	1	5.9	10	7.5	1.0
Use of efavirenz
Yes	0	0.0	39	29.3	1.1	1.0 - 1.2	0.010
No	17	100.0	94	70.7	1.0
Had COVID-19
No	16	94.1	118	88.7	2.0	0.2 - 16.4	0.499
Yes	1	5.9	15	11.3	1.0

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[1] Corresponding author: Gilmara Holanda da Cunha E-mail: gilmaraholandaufc@yahoo.com.br