Physical symptoms, beliefs about medications, negative mood, and long-term HIV medication adherence.
BACKGROUND
Near-perfect levels of HIV medication adherence are necessary for treatment to be successful. However, many patients continue to report nonadherence to HIV treatment.


OBJECTIVE
This study examines the relationship between symptoms of HIV and medication adherence and evaluates beliefs about HIV medications and negative mood states as potential mediators of this relationship.


METHODS
These relationships were tested with structural equation modeling using a 15-month longitudinal design. The ethnically diverse convenience sample included 325 HIV-infected men who have sex with men and women prescribed Highly Active Antiretroviral Therapy (HAART).


RESULTS
Results showed that a greater number of symptoms were associated with poorer medication adherence, and this relationship was partially mediated by increases in concerns about HAART. Contrary to expectations, negative mood states were not directly related to medication adherence. In the final model, concerns about HAART and general distrust of medications each predicted poorer HAART adherence. Necessity beliefs about HAART and level of educational attainment each predicted better adherence. The final model accounted for approximately 24% of the variance in HAART adherence.


CONCLUSIONS
The results of this study suggest that Horne's (1) necessity-concerns framework can be successfully applied to identify beliefs about medication that are important predictors of adherence to HAART over time. These findings have relevance for developing interventions to improve medication adherence among HIV-infected patients.
Gonzalez
Jeffrey S
JS
Harvard Medical School/Massachusetts General Hospital, Department of Psychiatry, Boston 02114, USA. jsgonzalez@partners.org
Penedo
Frank J
FJ
Llabre
Maria M
MM
Durán
Ron E
RE
Antoni
Michael H
MH
Schneiderman
Neil
N
Horne
Rob
R
D000328:Adult; D000339:Affect; D023241:Antiretroviral Therapy, Highly Active / Q000523:psychology*; D001294:Attitude to Health; D003469:Culture; D005260:Female; D005500:Follow-Up Studies; D015658:HIV Infections / Q000188:drug therapy*; D006801:Humans; D008297:Male; D010349:Patient Compliance / Q000706:statistics & numerical data*; D011795:Surveys and Questionnaires; D013997:Time Factors