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BACKGROUND: There are approximately 72,000 people living with HIV/AIDS (PLHIV) in Peru. Non-adherence to antiretroviral therapy (ART) is the most important factor for therapeutic failure and the development of resistance. Peru has achieved moderate progress in meeting the 90-90-90 targets, but only 60% of PLHIV receiving ART are virally suppressed. The purpose of this study was to understand ART adherence in the Peruvian context, including developing sociodemographic and clinical profiles, evaluating the clinical management strategies, and analyzing the relationships between the variables and adherence of PLHIV managed at a regional HIV clinic in Lambayeque Province (Northern Peru). METHODS: This was a cross-sectional study with 180 PLHIV adults, non-randomly but consecutively selected with self-reported ART compliance (78.2% of the eligible population). The PLHIV profile (PLHIV-Pro) and the Simplified Medication Adherence Questionnaire (SMAQ) were used to collect sociodemographic information, clinical variables, and data specific to ART adherence. Descriptive analysis of sociodemographic and clinical characteristics was performed. Bivariate analysis was performed with the Mann-Whitney test, Chi square test, and Yates correction. RESULTS: The 180 PLHIV sample included 78.9% men, 49.4% heterosexual, 45% with a detectable HIV-1 viral load less than 40 copies/ml, 58.3% not consistently adherent, and only 26.1% receiving Tenofovir + Lamivudine + Efavirenz. Risk factors significant for non-adherence included concurrent tuberculosis, discomfort with the ART regime, and previous pauses in ART. Multivariate analysis of nested models indicated having children is a protector factor for adherence. CONCLUSIONS: Self-reported adherence appeared to be low and the use of first-line therapy is not being prescribed homogeneously. Factors associated with nonadherence are both medical and behavioral, such as having tuberculosis, pausing ART, or experiencing discomfort with ART. The Peruvian government needs to update national technical standards, monitor medication availability, and provide education to health care professionals in alignment with evidence-based guidelines and international recommendations. Instruments to measure adherence need to be developed and evaluated for use in Latin America.

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Resumen: Arch Med Interna 2013 - 35(1):05-08 Las complicaciones neurológicas son frecuentes en los pacientes afectados por el virus de inmunodeficiencia humana (VIH). Se realizó un estudio descriptivo, retrospectivo, para conocer la frecuencia de la patología neurológica en los pacientes VIH/SIDA (síndrome de inmunodeficiencia adquirida) de nuestro centro, su perfil clínico y evolutivo, comparar el grado de inmunodepresión, el tiempo de estadía hospitalaria, la gravedad de la afección (estimada por requerimiento de ingreso a CTI) y la mortalidad entre los pacientes que se presentaban con enfermedades oportunistas (EO) y enfermedades no oportunistas (ENO). Se encontró una alta prevalencia de enfermedad neurológica (21%), en población joven, en su mayoría de sexo masculino, con inmunodepresión muy severa, predominando la etapa SIDA; las EO son las más frecuentes y registran mayor morbimortalidad que las ENO. Nuestra población no registra la transición epidemiológica del mundo desarrollado vinculado al uso de terapia antirretroviral (TARV), hecho que atribuímos a sus condiciones socio-económico-culturales.

Abstract: Arch Med Interna 2013 - 35(1):05-08 Neurological complications are common in patients with human immunodeficiency virus (HIV). We conducted a descriptive study, to determine the frequency of neurological disease in HIV/AIDS (acquired immunodeficiency syndrome) in our center, their clinical and developmental profile, and compare the degree of immunosuppression, the length of hospital stay, severity of the condition (estimated income requirement to intensive care unit [ICU]) and mortality between the patients presenting with opportunistic disease (OD) and non-opportunistic disease (NOD). High prevalence of neurological disease (21%) was found, mostly in young people, male, with severe immunosuppression, dominating the AIDS stage. ODs are more frequent and have higher recorded morbidity than NOD. Our population does not record the epidemiological transition seen in the developed world linked to the use of antiretroviral therapy (ART), a fact we attribute to the socio-economic-cultural situation.