Alternative therapy use in HIV-infected patients receiving highly active antiretroviral therapy

Abstract

The extent of use of alternative therapies, psychosocial and disease-specific variables predictive of alternative therapy use, and factors motivating the use of alternative therapies in HIV-infected patients receiving highly active antiretroviral therapy (HAART) have not been well defined. Types of alternative therapies used, demographic and medical data, coping (Billing and Moos inventory of coping with illness styles), social support (Irwing and Sarason questionnaire), sense of personal control (Pearlin's Mastery scale), quality of life (Medical Outcome Study scale), health beliefs, and adherence rate were prospectively assessed in 118 HIV-infected patients receiving HAART. Of 38% (45/118) of the patients who used alternative therapies, 56% (25/45) began using alternative therapies since the initiation of HAART. While Caucasian patients were more likely to use alternative therapies than all other patients (P = 0.015), new users of alternative therapies were more likely to be African-American (P = 0.022). Alternative therapy users reported less satisfaction with their emotional support (P = 0.027), and had greater psychological distress (P = 0.048), but were more likely to utilize problem-focused coping (P = 0.015). Patients who used alternative therapies were less likely to believe that HAART was beneficial (P = 0.06). Physicians were unaware of patients' alternative therapy use in 40% (18/45) of all patients who used alternative therapies, in 67% of herbal therapy users, and in 100% of dietary supplement users. Adherence to antiretroviral therapy, CD4 count, and HIV-RNA level were neither predictive nor affected by alternative therapy use. Despite scepticism about the benefits of HAART, resort to alternative therapies did not undermine adherence with antiretroviral therapy. Although able actively to cope with their illness, users of alternative therapies had greater psychological distress and were less satisfied with their emotional support. Interventions aimed at promoting their psychological well-being and enhancing the emotional support should be considered in these patients.

Herb-Drug Interaction between Echinacea purpurea and Etravirine in HIV-Infected Patients

“…ore than half of HIV-infected patients express interest in taking some kind of complementary therapy in addition to their antiretroviral regimens at some point during the course of treatment (15,16,19). These patients usually choose dietary and herbal supplements and take them without medical supervision.…”

Drug interactions with antiretrovirals

“…Thirty-eight percent of respondents used alternative therapies in a survey of 118 HIV-infected patients receiving highly active antiretroviral therapy. Of particular concern is that physicians were unaware of the patients' alternative therapy use in 67% of herbal therapy users and 100% of dietary supplement users [46]. In light of several recent investigations that showed that complementary alternative medicine significantly altered antiretroviral blood concentrations, many investigators have turned their attention to the combination of herbal remedies and antiretroviral medications.…”

Consumo de plantas medicinales en los pacientes infectados por el virus de la inmunodeficiencia humana. Patrones de uso y factores relacionados

“…El uso de TAC parece ser comú n en los pacientes infectados por el virus de la inmunodeficiencia humana (VIH), sin que haya disminuido a pesar de la actual disponibilidad de los llamados esquemas de tratamiento antirretroviral de gran actividad (TARGA) [5][6][7][8][9][10][11][12][13][14][15] . No obstante, la prevalencia del uso de TAC varía notablemente entre los diferentes estudios publicados en la literatura mé dica [5][6][7][8][9][10][11][12][13][14][15] , probablemente debido a diferencias sociodemográ ficas entre las poblaciones estudiadas, que hacen que los resultados obtenidos en una població n no sean extrapolables al resto.…”

“…No obstante, la prevalencia del uso de TAC varía notablemente entre los diferentes estudios publicados en la literatura mé dica [5][6][7][8][9][10][11][12][13][14][15] , probablemente debido a diferencias sociodemográ ficas entre las poblaciones estudiadas, que hacen que los resultados obtenidos en una població n no sean extrapolables al resto. Por este motivo, conocer la prevalencia del consumo de TAC y de los factores relacionados con el mismo en una població n específica es de gran interé s para los mé dicos clínicos, sobre todo cuando se refiere a sustancias con riesgo potencial de poner en peligro de la salud de los pacientes, como las plantas medicinales.…”

“…Los pacientes a menudo perciben los TAC como remedios má s saludables y seguros que los medicamentos convencionales, y en muchas ocasiones los usan por decisió n propia y sin conocimiento alguno por parte del mé dico [9][10][11][12][13][14][15] . Sin embargo, existe evidencia de que combinar ciertos TAC con el TARGA puede resultar peligroso 11,16 .…”