Prevalence of behavioral risk factors in people with HIV/AIDS and its’ effect on adherence to treatment

Introduction
Behavioral risk factors, in addition to increasing the risk of human immunodeficiency virus (HIV)/acquired immunodeficiency syndrome (AIDS) transmission, can affect antiretroviral the­rapy (ART) compliance of people with the condition. The aim of this study was to determine the pre­valence of behavioral risk factors and its’ effect on adherence to antiretroviral drugs (ARV) treatment in patients with HIV/AIDS in Western Iran.

Material and methods
This study was performed among all patients diagnosed with HIV/AIDS in Kermanshah Province for 25 years, from 1995 till 2019. Adherence to treatment in these patients was divided into three categories according to the World Health Organization definition, i.e., non-adherence, cessation, and adherence to treatment. Using single-variable and multi-variable logistic regression, the effect of important variables in four models was modified, and the effect of each of behavioral risk factors was analyzed in patients with non-adherence or experienced cessation compared to those who adhered to ARV.

Results
Of the 2,867 patients with HIV/AIDS, 2,449 (85.42%) were males. The mean age of HIV infection was 33.36 ± 11.8 years. In 1995, less than 10 percent of people received treatment, and in 2019, it was more than 67 percent. All behavioral risk factors increased non-adherence to medication and cessation of ARV. In general, after controlling confounding variables, except for needle sharing, all behavioral variables affected ARV treatment. The greatest impact on non-adherence to medication was history of drug abuse, history of imprisonment, history of injection drug use, and sex with non-spouse, with a chance of 10.87 (range, 7.21-16.39), 3.94 (range, 2.84-5.46), 3.86 (range, 2.47-6.03), and 3.38 (range, 2.19-5.23) times more than patients without these risk factors, respectively.

Conclusions
Although the process of receiving treatment has been increasing since 2005, the non-adherence to medication is still high in high-risk groups; therefore it is important to focus more on reducing non-adherence and eventual cessation of treatment. In particular, more attention is necessary for health education and raising the level of awareness of these groups.