HIV or HIV-therapy? Causal attributions of symptoms and their impact on treatment decisions among women and men with HIV.
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.
Kremer
H
H
All Around Women Special, German AIDS Society, Sigmund-Freud-Str. 25, 53105 Bonn, Germany. HeidemarieKremer@yahoo.de
Sonnenberg-Schwan
U
U
Arendt
G
G
Brockmeyer
N H
NH
Potthoff
A
A
Ulmer
A
A
Graefe
K
K
Lorenzen
T
T
Starke
W
W
Walker
U A
UA
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
D019380:Anti-HIV Agents