Effect of individual cognitive behaviour intervention on adherence to antiretroviral therapy: prospective randomized trial.
OBJECTIVE
A high level of adherence to antiretroviral therapy is required for complete suppression of HIV replication, immunological and clinical effectiveness. We investigated whether cognitive behaviour therapy can improve medication adherence.


METHODS
Prospective randomized 1-year trial.


METHODS
Collaboration of HIV university outpatient clinic and psychotherapists in private practice.


METHODS
60 HIV-infected persons on stable antiretroviral combination therapy and viral load below 50 copies/ml.


METHODS
Cognitive behaviour intervention in individual patients, in addition to standard of care.


METHODS
Feasibility and acceptance of intervention; adherence to therapy assessed using medication event monitoring system (MEMS) and self-report questionnaire; virological failure; psychosocial measures.


RESULTS
The median number of sessions for cognitive behaviour intervention per patient during the 1-year trial was 11 (range 2-25). At months 10-12, mean adherence to therapy as assessed using MEMS was 92.8% in the intervention and 88.9% in the control group (P=0.2); the proportion of patients with adherence > or = 95% was 70 and 50.0% (P=0.014), respectively. While there was no significant deterioration of adherence during the study in the intervention arm, adherence decreased by 8.7% per year (P=0.006) in the control arm. No differences between the intervention group and standard of care group were found regarding virological outcome. Compared with the control group, participants in the intervention group perceived a significant improvement of their mental health during the study period.


CONCLUSIONS
Cognitive behavioural support in addition to standard of care of HIV-infected persons is feasible in routine practice, and can improve medication adherence and mental health.
Weber
Rainer
R
Division of Infectious Diseases and Hospital Epidemiology, University Hospital, Zurich, Switzerland. infweb@usz.unizh.ch
Christen
Lisanne
L
Christen
Stephan
S
Tschopp
Simone
S
Znoj
Hansjoerg
H
Schneider
Christine
C
Schmitt
Joachim
J
Opravil
Milos
M
Günthard
Huldrych F
HF
Ledergerber
Bruno
B
D000328:Adult; D000368:Aged; D019380:Anti-HIV Agents / Q000627:therapeutic use*; D003071:Cognition / Q000187:drug effects / Q000502:physiology*; D016903:Drug Monitoring / Q000523:psychology; D004522:Educational Status; D005260:Female; D015658:HIV Infections / Q000188:drug therapy* / Q000523:psychology*; D015497:HIV-1 / Q000302:isolation & purification*; D006801:Humans; D008297:Male; D008875:Middle Aged; D010349:Patient Compliance; D011446:Prospective Studies; D011613:Psychotherapy; D012367:RNA, Viral / Q000097:blood / Q000302:isolation & purification; D011795:Surveys and Questionnaires; D013997:Time Factors; D019562:Viral Load
D019380:Anti-HIV Agents; D012367:RNA, Viral