Psychospołeczne uwarunkowania postępowania terapeutycznego u chorych zakażonych wirusem HIV stosujących dożylne środki odurzające

• Authors: Marek Beniowski , Grzegorz Wagner , Włodzimierz Mazur

Title variants

EN

Psychosocial aspects of therapeutic management among HIV infected patients addicted to intravenous drugs

• Languages of publication: PL

Abstracts

PL

Na świecie zakażenie HIV u osób przyjmujących dożylne środki uzależniające (OPDŚU) może wynosić 13,2 mln osób, a 80% z nich żyje w krajach rozwijających się. Wysoce aktywną terapię antyretrowirusową (HAART) przyjmuje ok. 15% OPDŚU. Złe wykorzystanie HAART u OPDŚU zostało opisane zarówno w krajach europejskich jak i w USA. Czynnikiem, który warunkuje powodzenie terapii antyretrowirusowej jest adherencja. Pacjenci programów substytucyjnych często osiągają poziom adherencji i skuteczność HAART zbliżoną do uzyskiwanej u osób nigdy nieuzależnionych. Nie wszystkie osoby przyjmujące dożylne środki uzależniające mają możliwość stosować się do zaleceń terapeutycznych i mieć dobre warunki socjalno-ekonomiczne. Natomiast wiele badań wskazują, że HAART stosowane jeden raz dziennie jest równie efektywne, jak leczenie stosowane dwa razy dziennie. Większość badaczy zwraca uwagę na brak różnicy w postępie zakażenia HIV pomiędzy OPDŚU a osobami, które nabyły zakażenie w inny sposób. Znacznie częstsze jest występowanie chorób, które nie należą do schorzeń defi niujących AIDS, natomiast w istotny sposób wpływają na losy narkomanów dożylnych zakażonych HIV. Ważnym elementem jest współzakażenie wirusem HCV, które może dotyczyć ponad 95% OPDŚU. U osób leczonych HAART sposobem na poprawienie adherencji jest tzw. leczenie bezpośrednio obserwowane – Directly Observed Therapy. Leki antyretrowirusowe poprzez wpływ na układ cytochromu P450 (głównie na CYP3A4) wchodzą w interakcje, które muszą być właściwie diagnozowane. Pacjenci programów substytucyjnych, u których wdraża się HAART z udziałem leków antyretrowirusowych powinni być przygotowani na wzrost zapotrzebowania na opioidy i ewentualne objawy niedoboru.

EN

There are 13.2 million HIV infected persons addicted to intravenous drugs (AIDs) and 80% of them live to developing countries. Highly Active Antiretroviral Therapy (HAART) is provided to 15% of AIDs persons. Improper provision of HAART to AIDs persons was described both to Europe and to the USA. The factor which is responsible to HAART is adherence. The patients on substitutive treatment can achieve quite often the level of adherence and HAART eff ectiveness similar to persons not addicted to drugs. But not all addicted patients can follow medically advised treatment and live in good social position and that infl uences inappropriate results of provided support. Many investigators do confi rm that there is no diff erence for activity of HIV infection to general population comparing to AIDs patients. Still there is some data that HAART can be provided to patients even in once daily mode. There are many infections which are infl uencing drug users history – i.e. tuberculosis, abscesses or STDs. About 95% of patients do suff er from HCV infection world wide. Adherence is very important to the treatment provided to drug users and sometimes drugs could be provided as Directly Observed Therapy – DOT. Antireroviral drugs thanks to the infl uence of cytochrome P450 (mainly CYP3A4) can develop interactions and should be properly medically adapted. Patients from the substitutive programs who are receiving antiretrovirals should be prepared for increased requirement of opioids and signs of the drugs defi ciency to the patients.

Keywords

EN

HIV infection; addiction to intravenous drugs; uzależnienie od dożylnych środków odurzających; zakażenie HIV

Discipline

• MEDICINE: MEDICINE

• Publisher: Śląski Uniwersytet Medyczny w Katowicach
• Journal: Annales Academiae Medicae Silesiensis
• Year: 2009
• Volume: 63
• Issue: 2
• Pages: 48-58

Contributors

author

Marek Beniowski

• Katedra i Oddział Kliniczny Chorób Zakaźnych, 41-500 Chorzów, ul. Zjednoczenia 10, tel. [phone], fax [phone]

author

Grzegorz Wagner

• Katedra i Oddział Kliniczny Chorób Zakaźnych SUM w Katowicach

author

Włodzimierz Mazur

• Katedra i Oddział Kliniczny Chorób Zakaźnych SUM w Katowicach

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• Document Type: article