The relationship between gastrointestinal symptom attribution, bothersomeness, and antiretroviral adherence among adults with HIV

Abstract

Patients who attribute their symptoms to HIV medications, rather than disease, may be prone to switching antiretrovirals (ARVs) and experience poor retention/adherence to care. Gastrointestinal (GI) symptoms (e.g., nausea/vomiting) are often experienced as a side effect of ARVs, but little is known about the relationship of symptom attribution and bothersomeness to adherence. We hypothesized that attribution of a GI symptom to ARVs is associated with a reduction in adherence, and that this relationship is moderated by the bothersomeness of the symptom. Data for our analysis come from the pre-randomization enrollment period of a larger study testing an adherence improvement intervention. Analyses revealed that patients with diarrhea who attributed the symptom to ARVs (compared to those who did not) had significantly worse adherence. We did not find a significant moderating effect of bothersomeness on this relationship. Incorporating patient beliefs about causes of symptoms into clinical care may contribute to improved symptom and medication management, and better adherence.

Patient-Reported Outcomes in an Observational Cohort of HIV-1-Infected Adults on Darunavir/Cobicistat-Based Regimens: Beyond Viral Suppression

“…We found a reduction in the overall population at V4 in percentages of patients experiencing fatigue and gastrointestinal symptoms such as diarrhea and bloating, but not nausea. Notably, gastrointestinal symptoms, usually related to PI/r treatment, may significantly affect patient compliance [35]; these symptoms decreased from V1 to V4, thus showing a clear advantage in terms of tolerability when switching from PI/r-based treatments to DRV/c. Interestingly, in the present study, only six nausea events were reported as AEs by the clinicians.…”

Παράγοντες Που Σχετίζονται Με Την Ελλιπή Συμμόρφωση Ασθενών Κατά Την Αντιρετροΐκή Αγωγή Για Την Αντιμετώπιση Λοίμωξης Από Τον Ιό Της Επίκτητης Ανοσολογικής Ανεπάρκειας

“…Επίσης, οι μακροπρόθεσμες συνέπειες μια ισχυρής αντιρετροϊκής αγωγής είναι δύσκολο να προβλεφθούν. Ο αριθμός και η σειρά των ανεπιθύμητων ενεργειών που σχετίζονται με την αγωγή μπορεί να αποβούν υπερβολικά πιεστικές και μη αντιμετωπίσιμες για τον ασθενή(Robertson and Keller, 1992;Swan et al, 2018). Οι ανεπιθύμητες ενέργειες, η πολυπλοκότητα της καθημερινότητας, ο αριθμός των δισκίων/ δόσεων και οι μακροπρόθεσμες αβεβαιότητες είναι πολύ βασικοί παράγοντες που επηρεάζουν την ικανότητα του ασθενούς να ανταποκριθεί αποτελεσματικά στην αγωγή.Στην έρευνα τωνLenzi et al, (2013) οι ανεπιθύμητες ενέργειες συνδυάστηκαν με 12 φάρμακα, εκ των οποίων το 58,3% ήταν NRTIs.…”