Sustained antiretroviral treatment adherence in survivors of the pre-HAART era: attitudes and beliefs

• Published in: AIDS care Vol. 20; no. 7; pp. 796 - 805
• Main Authors: Fumaz, C.R., Muñoz-Moreno, J.A., Moltó, J., Ferrer, M.J., López-Blázquez, R., Negredo, E., Paredes, R., Gómez, G., Clotet, B.
• Format: Journal Article
• Language: English
• Published: Abingdon Taylor & Francis Group 01-08-2008; Taylor & Francis; Taylor & Francis Ltd; Taylor & Francis (Routledge)
• Subjects: Adherence; Adult; AIDS; AIDS/HIV; Antibiotics. Antiinfectious agents. Antiparasitic agents; Antiretroviral drugs; Antiretroviral therapy; Antiretroviral Therapy, Highly Active; antiretroviral treatment; Antiviral agents; Attitude to Health; Attitudes; Biological and medical sciences; Cross-Sectional Studies; Data analysis; Drug Administration Schedule; Drug therapy; Female; Fundamental and applied biological sciences. Psychology; Health behavior; Health behaviour; Health beliefs; Health care; Hepatitis C virus; highly experienced patients; HIV; HIV Infections - drug therapy; HIV Infections - psychology; HIV Long-Term Survivors; HIV-1; Human immunodeficiency virus; Humans; Illness; Illness and personality; Male; Medical care; Medical sciences; Medical treatment; Middle Aged; Patient Compliance - statistics & numerical data; Perceptions; Personality, behavior and health; Pharmacology. Drug treatments; Psychology and medicine; Psychology. Psychoanalysis. Psychiatry; Psychology. Psychophysiology; Regression analysis; Risk perception; Sexually transmitted diseases; Spain; Studies; Survival analysis; Treatment Outcome; Europe; Spain; Belief; Social environment; Human; Immunopathology; Antiretroviral agent; Attitude; Survivor; Mental health; Pharmacotherapy; AIDS; Immune deficiency; Infection; Drug compliance; Treatment; Viral disease; Cross sectional study; Antiviral; Treatment compliance; Public health; Life Sciences
• ISSN: 0954-0121; 1360-0451
• DOI: 10.1080/09540120701694022

The objective of this study was to assess adherence of HIV-1-infected patients who started treatment in the pre-HAART era and to determine variables associated with better adherence, including relevant attitudes and beliefs. This is a cross-sectional study enrolling patients who had received antiretroviral therapy for ≥10 years. Adherence was evaluated through self-reporting and plasma drug concentrations. Treatment variables, attitudes and beliefs were collected during structured interviews. The results show that for 87 patients the median (interquartile range) time on therapy was 13 (10-19) years; 80 were on therapy at the time of analysis. Adherence was ≥95% in 54 patients (67.5%), 90-94% in 22 (27.5%) and <90% in 4 (5%). Drug concentrations were below the lower limit of detection in five patients. Younger age (p=0.014), female gender (p=0.005), current substance abuse (p=0.004) and hepatitis C virus co-infection (p<0.001) were related to lower adherence. Adherence did not differ in relation to different drug families or once- or twice-daily regimens. Patients with adherence <95% were more likely to have interrupted treatment without doctor's recommendation (p=0.009). Adherent patients exhibited a higher perception of risk of developing the illness and of benefits of therapy, higher self-efficacy and intention to adhere and were more influenced by events that motivate medication intake. To conclude, adherence was >90% in most patients on antiretroviral therapy for ≥10 years. Adherence was more related to beliefs about health and illness than to the characteristics of medication or level of knowledge about treatment. Care adherence interventions should include assessment of health beliefs.