The influence of symptom experiences and attributions on adherence to highly active anti-retroviral therapy (HAART): a six-month prospective, follow-up study.
OBJECTIVE
To examine changes in individuals' experiences of symptoms over the first six months of taking highly active anti-retroviral therapy (HAART) and to assess the impact of symptom experiences and attributions on adherence to HAART.


METHODS
A prospective study where consecutive HIV positive individuals initiating HAART completed validated questionnaires assessing their experiences of symptoms, depression, beliefs about HAART and adherence, before starting treatment and after one, three and six months of treatment.


RESULTS
Rates of low (<95%) adherence to HAART increased over time (p<0.001). Overall, the number of HIV or HAART-related symptoms reported did not change significantly over follow-up. However, symptom experiences differed between those reporting high (> or =95%) adherence and those reporting low adherence. Individuals reporting high adherence experienced a decrease in symptoms they attributed to HIV (p<0.05), and a decrease in the symptoms they attributed to HAART-side effects (p<0.05) over time. This decrease in symptoms over time was not seen among individuals reporting low adherence. A lack of symptomatic improvement was associated with increasing doubts about the continued necessity for HAART (p<0.05).


CONCLUSIONS
The findings suggest that adherence to HAART is influenced by individuals' experiences of both HIV and HAART-related symptoms. Patients who experience persistent symptoms while on HAART may begin to doubt their continued need for treatment and respond by missing doses. These findings have implications for the development of evidence-based interventions to increase adherence.
Cooper
V
V
Department of Policy and Practice, Centre for Behavioural Medicine, School of Pharmacy, University of London, Tavistock Square, London.
Gellaitry
G
G
Hankins
M
M
Fisher
M
M
Horne
R
R
D000293:Adolescent; D000328:Adult; D023241:Antiretroviral Therapy, Highly Active / Q000009:adverse effects*; D001294:Attitude to Health; D004812:Epidemiologic Methods; D015658:HIV Infections / Q000188:drug therapy*; D015438:Health Behavior; D006801:Humans; D008297:Male; D055118:Medication Adherence / Q000523:psychology*; D008875:Middle Aged; D055815:Young Adult