ORIGINAL ARTICLE
HIV therapy adherence and outcomes in Peruvian military personnel over a 30-year period
 
More details
Hide details
1
Universidad Científica del Sur, Lima, PERU
 
2
Department of Infectious Diseases, Hospital Nacional Edgardo Rebagliati Martins, Lima, PERU
 
3
South American Center for Education and Research in Public Health, Universidad Norbert Wiener, Lima, PERU
 
4
Universidad Peruana de Ciencias Aplicadas, Lima, PERU
 
5
Internal Medicine, Hospital Militar Central “Luis Arias Schereiber”, Lima, PERU
 
 
Online publication date: 2023-01-01
 
 
Publication date: 2023-03-01
 
 
Electron J Gen Med 2023;20(2):em443
 
KEYWORDS
ABSTRACT
Objectives:
We aimed to describe the sociodemographic, clinical, and therapeutic characteristics of Peruvian military personnel diagnosed with HIV. Furthermore, we determined the frequency of highly active antiretroviral therapy (HAART) adherence, the complications and mortality.

Methods:
We retrospectively reviewed the medical records of patients diagnosed with HIV, confirmed by Western blot at a single institution from 1989-2020. Descriptive analyses were performed for all the variables using mean and standard deviation (SD) in the case of quantitative variables, and frequency and percentage for qualitative variables.

Results:
Of the 161 patients included, 95.7% were males and the mean age was 39.59 years (SD= 16.45 years). Most had college or higher education (67.7%) and were on active duty at diagnosis (77%). 35.4% had AIDS at diagnosis; 28.6% opportunistic infections; and 8.1% tuberculosis. The median follow-up was five years. 94.4% of the patients received HAART as the principal treatment; of these, 88.8% was adherent to treatment, and death was reported in 6.8%. There were no factors associated with adherence.

Conclusions:
Although the sociodemographic characteristics of Peruvian military personnel are similar to those of other countries, our findings suggest that Peruvian military personnel present higher adherence to HAART compared to previous studies in other military populations from South American countries. Further studies are recommended to assess specific factors attributed to these successful outcomes in the military personnel that can be applied in other hospitals.

REFERENCES (39)
1.
Siefried KJ, Mao L, Kerr S, et al. Socioeconomic factors explain suboptimal adherence to antiretroviral therapy among HIV-infected Australian adults with viral suppression. PLoS One. 2017;12(4):e0174613. https://doi.org/10.1371/journa... PMid:28369066 PMCid:PMC5378347.
 
2.
Semvua SK, Orrell C, Mmbaga BT, Semvua HH, Bartlett JA, Boulle AA. Predictors of non-adherence to antiretroviral therapy among HIV infected patients in northern Tanzania. PLoS One. 2017;12(12):e0189460. https://doi.org/10.1371/journa... PMid:29252984 PMCid:PMC5734684.
 
3.
Marconi VC, Grandits GA, Weintrob AC, et al. Outcomes of highly active antiretroviral therapy in the context of universal access to healthcare: The U.S. military HIV natural history study. AIDS Res Ther. 2010;7:14. https://doi.org/10.1186/1742-6... PMid:20507622 PMCid:PMC2894737.
 
4.
Paterson DL, Swindells S, Mohr J, et al. Adherence to protease inhibitor therapy and outcomes in patients with HIV infection. Ann Inter Med. 2000;133(1):21-30. https://doi.org/10.7326/0003-4... PMid:10877736.
 
5.
Ortego C, Huedo-Medina TB, Llorca J, et al. Adherence to highly active antiretroviral therapy (HAART): A meta-analysis. AIDS Behav. 2011;15(7):1381-96. https://doi.org/10.1007/s10461... PMid:21468660.
 
6.
Mgbere O, Monjok E, Abughosh S, Ekong E, Holstad MM, Essien EJ. Modeling covariates of self-perceived and epidemiologic notions of risk for acquiring STIs/HIV among military personnel: A comparative analysis. AIDS Behav. 2013;17(3):1159-75. https://doi.org/10.1007/s10461... PMid:22271332 PMCid:PMC3337945.
 
7.
Audet CM, Salato J, Vermund SH, Amico KR. Adapting an adherence support workers intervention: Engaging traditional healers as adherence partners for persons enrolled in HIV care and treatment in rural Mozambique. Implement Sci. 2017;12(1):50. https://doi.org/10.1186/s13012... PMid:28407813 PMCid:PMC5390357.
 
8.
Kim MJ, Lee SA, Chang HH, et al. Causes of HIV Drug Non-Adherence in Korea: Korea HIV/AIDS cohort study, 2006-2015. Infect Chemother. 2017;49(3):213-8. https://doi.org/10.3947/ic.201... PMid:29027388 PMCid:PMC5620388.
 
9.
Pacífico J, Gutiérrez C. Información sobre la medicación y adherencia al tratamiento antirretroviral de gran actividad en pacientes con VIH/SIDA de un hospital de Lima, Perú [Information on medication and adherence to highly active antiretroviral treatment in patients with HIV/AIDS at a hospital in Lima, Peru]. Rev Peru Med Exp Salud Publica. 2015;32(1):66-72. https://doi.org/10.17843/rpmes... PMid:26102107.
 
10.
Golin CE, Liu H, Hays RD, et al. A prospective study of predictors of adherence to combination antiretroviral medication. J Gen Intern Med. 2002;17(10):756-65. https://doi.org/10.1046/j.1525... PMid:12390551 PMCid:PMC1495120.
 
11.
Alvis Ó, De Coll L, Chumbimune L, Díaz C, Díaz J, Reyes M. Factores asociados a la no adherencia al tratamiento antirretroviral de gran actividad en adultos infectados con el VIH-sida [Factors associated with non-adherence to highly active antiretroviral treatment in adults infected with HIV-AIDS]. An Fac Med. 2009;70(4):266-72. https://doi.org/10.15381/anale....
 
12.
Mendoza M, Meneses C, Montilla N, Mosquera N, Nuñez G. Adherencia al tratamiento antirretroviral y factores asociados en pacientes con VIH que acuden a la consulta de PRONASIDALara. Julio-Octubre 2009 [Adherence to antiretroviral treatment and associated factors in patients with HIV who attend the PRONASIDALara clinic. July-October 2009]. Surgeon thesis, Universidad Centroccidental Lisandro Alvarado; 2009.
 
13.
Acurcio Fde A, Puig-Junoy J, Bonolo Pde F, Braga Ceccato M, Guimarães MD. [Cost-effectiveness of initial adherence to antiretroviral therapy among HIV infected patients in Belo Horizonte, Brazil]. Rev Esp Salud Publica. 2006;80(1):41-54. https://doi.org/10.1590/S1135-... PMid:16553259.
 
14.
Youn B, Shireman TI, Lee Y, Galárraga O, Wilson IB. Trends in medication adherence in HIV patients in the US, 2001 to 2012: An observational cohort study. J Int AIDS Soc. 2019;22(8):e25382. https://doi.org/10.1002/jia2.2... PMid:31441221 PMCid:PMC6706701.
 
15.
Cabrera-Rioja L. Lineamientos de un plan estratégico para el mejoramiento de la calidad del servicio brindado en el Hospital Militar Central de Lima: Universidad Nacional Mayor de San Marcos [Guidelines of a strategic plan to improve the quality of the service provided at the Central Military Hospital of Lima: Universidad Nacional Mayor de San Marcos]; 2007.
 
16.
Pimentel-Rodriguez M, Bisso-Andrade A. Levels of anxiety and depression in patient symptomatic and symptomatic VIH/SIDA. Bol Soc Peru Med Interna. 2000;13(1):8-12.
 
17.
Anglemyer A, Haber N, Noiman A, et al. HIV care continuum and meeting 90-90-90 targets: Cascade of care analyses of a U.S. military cohort. Mil Med. 2020;185(7-8):e1147-54. https://doi.org/10.1093/milmed... PMid:32207528 PMCid:PMC7429920.
 
18.
Achappa B, Madi D, Bhaskaran U, Ramapuram JT, Rao S, Mahalingam S. Adherence to antiretroviral therapy among people living with HIV. N Am J Med Sci. 2013;5(3):220-3. https://doi.org/10.4103/1947-2... PMid:23626959 PMCid:PMC3632027.
 
19.
Peppe C. Prevalencia de la infección por VIH entre militares integrantes de Misiones de Paz [Prevalence of HIV infection among military members of Peace Missions]. Salud Militar. 2011;30(1):53-8. https://doi.org/10.35954/SM201....
 
20.
Hakre S, Mydlarz DG, Dawson P, et al. Epidemiology of HIV among US Air Force military personnel, 1996-2011. PLoS One. 2015;10(5):e0126700. https://doi.org/10.1371/journa... PMid:25961564 PMCid:PMC4427109.
 
21.
Rimoin AW, Hoff NA, Djoko CF, et al. HIV infection and risk factors among the armed forces personnel stationed in Kinshasa, Democratic Republic of Congo. Int J std AIDS. 2014;26(3):187-95. https://doi.org/10.1177/095646... PMid:24828556.
 
22.
Gorbach PM, Sopheab H, Phalla T, et al. Sexual bridging by Cambodian men: Potential importance for general population spread of STD and HIV epidemics. Sex Transm Dis. 2000;27(6):320-6. https://doi.org/10.1097/000074... PMid:10907906.
 
23.
Whiteside A, Vinnitchok A, Dlamini T, Mabuza K. Mixed results: The protective role of schooling in the HIV epidemic in Swaziland. Afr J AIDS Res. 2017;16(4):305-13. https://doi.org/10.2989/160859... PMid:29132280.
 
24.
Sarma H, Oliveras E. Implementing HIV/AIDS education: Impact of teachers’ training on HIV/AIDS education in Bangladesh. J Health Popul Nutr. 2013;31(1):20-7. https://doi.org/10.3329/jhpn.v... PMid:23617201 PMCid:PMC3702355.
 
25.
Singer DE, Bautista CT, O’Connell RJ, et al. HIV infection among U.S. Army and Air Force military personnel: Sociodemographic and genotyping analysis. AIDS Res Hum Retroviruses. 2010;26(8):889-94. https://doi.org/10.1089/aid.20... PMid:20673143.
 
26.
Essien EJ, Ogungbade GO, Ward D, et al. Influence of educational status and other variables on human immunodeficiency virus risk perception among military personnel: A large cohort finding. Mil Med. 2007;172(11):1177-81. https://doi.org/10.7205/MILMED... PMid:18062392 PMCid:PMC2137161.
 
27.
Yabes JM, Jr, Schnarrs PW, Foster LB, Jr, Scott PT, Okulicz JF, Hakre S. The 3 levels of HIV stigma in the United States military: Perspectives from service members living with HIV. BMC Public Health. 2021;21(1):1399. https://doi.org/10.1186/s12889... PMid:34266390 PMCid:PMC8281656.
 
28.
Kouanfack OSD, Kouanfack C, Billong SC, et al. Epidemiology of opportunistic infections in HIV infected patients on treatment in accredited HIV treatment centers in Cameroon. IntJ MCH AIDS. 2019;8(2):163-72. https://doi.org/10.21106/ijma.... PMid:32257607 PMCid:PMC7099574.
 
29.
Villaran MV, Bayer A, Konda KA, et al. Condom use by partner type among military and police personnel in Peru. Am J Mens Health. 2012;6(4):266-72. https://doi.org/10.1177/155798... PMid:22398988 PMCid:PMC4080898.
 
30.
Apolaya-Segura M, Cárcamo-Cavagnaro C. Influencia del servicio militar voluntario sobre el comportamiento sexual de una población de jóvenes [Influence of voluntary military service on the sexual behavior of a population of young people]. Rev Peru Med Exp Salud Publica. 2013;30(3):386-92. https://doi.org/10.17843/rpmes....
 
31.
Reyes Rios LA, Campo Torregrosa EL, Espinosa Aguilar A, Granados Pérez AM, Gil Ruiz ID. Adherencia al tratamiento antirretroviral en personas con VIH/sida de la región Caribe-Colombiano [Adherence to antiretroviral treatment in people with HIV/AIDS in the Caribbean-Colombian region]. Rev Cubana Hig Epidemiol. 2020;57(0):1-16.
 
32.
Arístegui I, Dorigo A, Bofill L, et al. Barriers to adherence and retention in public and private healthcare according to patients and health workers. Actual SIDA Infectol. 2014;22(86):71-80.
 
33.
Rouleau G, Richard L, Côté J, Gagnon MP, Pelletier J. Nursing practice to support people living with HIV with antiretroviral therapy adherence: A qualitative study. J Assoc Nurses AIDS Care. 2019;30(4):e20-37. https://doi.org/10.1097/JNC.00... PMid:31241513 PMCid:PMC6594722.
 
34.
UNAIDS. Global HIV & AIDS statistics–2021 fact sheet, July 2021. UNAIDS; 2021. Available at: https://www.unaids.org/en/reso... (Accessed: 28 September 2022).
 
35.
Marcus JL, Leyden WA, Alexeeff SE, et al. Comparison of overall and comorbidity-free life expectancy between insured adults with and without HIV infection, 2000-2016. JAMA Netw Open. 2020;3(6):e207954. https://doi.org/10.1001/jamane... PMid:32539152 PMCid:PMC7296391.
 
36.
Jani C, Patel K, Walker A, et al. Trends of HIV mortality between 2001 and 2018: An observational analysis. Trop Med Infect Dis. 2021;6(4):173. https://doi.org/10.3390/tropic... PMid:34698297 PMCid:PMC8544718.
 
37.
Maduna PH, Dolan M, Kondlo L, et al. Morbidity and mortality according to latest CD4+ cell count among HIV positive individuals in South Africa who enrolled in project Phidisa. PLoS One. 2015;10(4):e0121843. https://doi.org/10.1371/journa... PMid:25856495 PMCid:PMC4391777.
 
38.
Agan BK, Ganesan A, Byrne M, et al. The US military HIV natural history study: Informing military HIV care and policy for over 30 years. Mil Med. 2019;184(Suppl 2):6-17. https://doi.org/10.1093/milmed... PMid:31778201 PMCid:PMC6886375.
 
39.
Poorolajal J, Hooshmand E, Mahjub H, Esmailnasab N, Jenabi E. Survival rate of AIDS disease and mortality in HIV-infected patients: A meta-analysis. Public Health. 2016;139:3-12. https://doi.org/10.1016/j.puhe....
 
eISSN:2516-3507
Journals System - logo
Scroll to top