Self-reported symptoms and medication side effects influence adherence to highly active antiretroviral therapy in persons with HIV infection.
OBJECTIVE
To identify variables predictive of nonadherence to highly active antiretroviral therapy (HAART) and to assess whether self-reported symptoms or medication side effects are related to adherence.


METHODS
Cross-sectional multicenter study Adherence Italian Cohort Naive Antiretrovirals [AdICONA] within the Italian Cohort Naive Antiretrovirals (ICONA).


METHODS
Participants receiving HAART completed a 16-item self-administered questionnaire to assess nonadherence in the last 3 days as well as the type and intensity of 24 common HIV- and HAART-related symptoms experienced during the last 4 weeks.


RESULTS
From May 1999 to March 2000, 358 persons were enrolled: 22% reported nonadherence and were less likely to have HIV RNA <500 copies/ml (odds ratio = 0.51; 95% confidence interval: 0.31-0.85). Frequency of moderate/severe symptoms or medication side effects in nonadherent participants ranged from 3.6% to 30%. On univariate analysis, nausea, anxiety, confusion, vision problems, anorexia, insomnia, taste perversion, and abnormal fat distribution were significantly associated with nonadherence. Nonadherent persons had a higher mean overall symptom score (12.3 +/- 9.2 versus 8.1 +/- 6.6; p <.001) and mean medication side effect score (2.9 +/- 2.7 versus 1.9 +/- 1.9; p <.001) when compared with adherent participants. In the multivariate analysis, nausea ( p =.003); anxiety ( p =.006); younger age ( p =.007); unemployment ( p <.001); not recalling name, color, and timing of drugs ( p =.009); running out of pills between visits ( p =.002); and being too busy ( p =.03) were independently associated with nonadherence in the last 3 days.


CONCLUSIONS
In addition to patient characteristics, medication-related variables, and reasons for nonadherence, patient-reported symptoms and medication side effects were significantly associated with adherence to HAART.
Ammassari
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Clinica delle Malattie Infettive, Università Cattolica del S. Cuore, Roma, Italy. aammassari@libero.it
Murri
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Pezzotti
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Trotta
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Ravasio
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De Longis
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Lo Caputo
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Narciso
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Pauluzzi
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Carosi
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Nappa
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Piano
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Lichtner
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Rezza
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Monforte
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Ippolito
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d'Arminio Moroni
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Wu
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Antinori
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D000328:Adult; D019380:Anti-HIV Agents / Q000009:adverse effects / Q000627:therapeutic use*; D023241:Antiretroviral Therapy, Highly Active; D003221:Confusion / Q000139:chemically induced; D003430:Cross-Sectional Studies; D005260:Female; D015658:HIV Infections / Q000188:drug therapy*; D018451:Homosexuality, Male; D006801:Humans; D007558:Italy; D008297:Male; D015999:Multivariate Analysis; D009325:Nausea / Q000139:chemically induced; D016017:Odds Ratio; D010349:Patient Compliance; D012647:Self-Assessment; D011795:Surveys and Questionnaires; D016896:Treatment Outcome; D014786:Vision Disorders / Q000139:chemically induced
D019380:Anti-HIV Agents