title: HIV or HIV-therapy? Causal attributions of symptoms and their impact on treatment decisions among women and men with HIV.
abstract: OBJECTIVE
  Among people with HIV, we examined symptom attribution to HIV or HIV-therapy, awareness of potential side effects and discontinuation of treatment, as well as sex/gender differences.
  
  
  METHODS
  HIV-patients (N=168, 46% female) completed a comprehensive symptom checklist (attributing each endorsed symptom to HIV, HIV-therapy, or other causes), reported reasons for treatment discontinuations and potential ART-related laboratory abnormalities.
  
  
  RESULTS
  Main symptom areas were fatigue/sleep/energy, depression/mood, lipodystrophy, and gastrointestinal, dermatological, and neurological problems. Top HIV-attributed symptoms were lack of stamina/energy in both genders, night sweats, depression, mood swings in women; and fatigue, lethargy, difficulties concentrating in men. Women attributed symptoms less frequently to HIV than men, particularly fatigue (p<.01). Top treatment-attributed symptoms were lipodystrophy and gastrointestinal problems in both genders. Symptom attribution to HIV-therapy did not differ between genders. Over the past six months, 22% switched/interrupted ART due to side effects. In women, side effect-related treatment decisions were more complex, involving more side effects and substances. Remarkably, women took predominantly protease inhibitor-sparing regimens (p=.05). Both genders reported only 15% of potential ART-related laboratory abnormalities but more than 50% had laboratory abnormalities. Notably, women had fewer elevated renal parameters (p<.01).
  
  
  CONCLUSIONS
  Men may attribute symptoms more often to HIV and maintain a treatment-regimen despite side effects, whereas women may be more prudent in avoiding treatment side effects. Lacking awareness of laboratory abnormalities in both genders potentially indicates gaps in physician-patient communication. Gender differences in causal attributions of symptoms/side effects may influence treatment decisions.
authors.affiliation: All Around Women Special, German AIDS Society, Sigmund-Freud-Str. 25, 53105 Bonn, Germany. HeidemarieKremer@yahoo.de
authors.forename: H
authors.initials: H
authors.lastname: Kremer
authors.forename: U
authors.initials: U
authors.lastname: Sonnenberg-Schwan
authors.forename: G
authors.initials: G
authors.lastname: Arendt
authors.forename: N H
authors.initials: NH
authors.lastname: Brockmeyer
authors.forename: A
authors.initials: A
authors.lastname: Potthoff
authors.forename: A
authors.initials: A
authors.lastname: Ulmer
authors.forename: K
authors.initials: K
authors.lastname: Graefe
authors.forename: T
authors.initials: T
authors.lastname: Lorenzen
authors.forename: W
authors.initials: W
authors.lastname: Starke
authors.forename: U A
authors.initials: UA
authors.lastname: Walker
mesh_terms: D000328:Adult; D019380:Anti-HIV Agents / Q000009:adverse effects*; D003430:Cross-Sectional Studies; D003657:Decision Making; D005221:Fatigue / Q000139:chemically induced; D005260:Female; D005767:Gastrointestinal Diseases / Q000139:chemically induced; D015658:HIV Infections / Q000188:drug therapy*; D039682:HIV-Associated Lipodystrophy Syndrome / Q000139:chemically induced; D006801:Humans; D008297:Male; D008875:Middle Aged; D010349:Patient Compliance; D011788:Quality of Life; D012737:Sex Factors; D011795:Surveys and Questionnaires; D016312:Treatment Refusal
chemical_list: D019380:Anti-HIV Agents