title: Illness Representations of HIV Positive Patients Are Associated with Virologic Success.
abstract: Introduction:It is important for HIV positive patients to be engaged in their care and be adherent to treatment in order to reduce disease progression and mortality. Studies found that illness representations influence adherence through the mediating role of coping behaviors. However, no study has ever tested if patient engagement to the visits mediate the relationship between illness perceptions and adherence. This study aimed to explore illness representations of HIV positive patients and test the hypothesis that illness representations predict adherence through the mediating role of a component of behavioral engagement.Methods:HIV-positive patients treated with highly active antiretroviral therapy (HAART) for at least one year and presenting to a check-up visit were eligible to participate in the study. Patients completed the Illness Perception Questionnaire-Revised. Behavioral engagement was measured based on the patients' clinical attendance to the check-up visits; adherence to HAART was measured by viral load. Undetectable viral load or HIV-RNA < 40 copies/ml were considered indexes of virologic success.Results:A total of 161 patients participated in the study. Most of them coherently attributed the experienced symptoms to HIV/HAART; perceived their condition as chronic, stable, coherent, judged the therapy as effective, and attributed their disease to the HIV virus and to their behavior or bad luck. The majority of patients (80.1%) regularly attended check-up visits and 88.5% of them reached virologic success. The mediation model did not show good fit indexes. However, a significant direct effect of two independent variables on virologic success was found. Specifically, the perception that the disease does not have serious consequences on patient's life and the prevalence of negative emotions toward HIV were associated with virologic success. On the contrary, the patient's perception that the disease has serious consequences on his/her life and the prevalence of positive emotions were associated with virologic failure. This model showed good fit indexes (CFI = 1; TLI = 1; RMSEA = 0.00; and WRMSR = 0.309).Discussion:Results do not support the mediating role of behavioral engagement in the relationship between illness representations and adherence. As perception of serious consequences coupled with positive emotions are directly associated with virologic failure, clinicians should take them into account to promote treatment adherence.
authors.affiliation: Unit of Clinical Psychology, Department of Health Sciences, University of Milan Milan, Italy.
authors.forename: Daniela
authors.initials: D
authors.lastname: Leone
authors.affiliation: Unit of Clinical Psychology, Department of Health Sciences, University of Milan Milan, Italy.
authors.forename: Lidia
authors.initials: L
authors.lastname: Borghi
authors.affiliation: Department of Biomedical Sciences, Humanitas University Milan, Italy.
authors.forename: Giulia
authors.initials: G
authors.lastname: Lamiani
authors.affiliation: Unit of Clinical Psychology, ASST Santi Paolo e Carlo, Presidio San Paolo University Hospital Milan, Italy.
authors.forename: Luca
authors.initials: L
authors.lastname: Barlascini
authors.affiliation: Clinic of Infectious Diseases, Department of Health Sciences, ASST Santi Paolo e Carlo, Presidio San Paolo University Hospital, University of Milan Milan, Italy.
authors.forename: Teresa
authors.initials: T
authors.lastname: Bini
authors.affiliation: Clinic of Infectious Diseases, Department of Health Sciences, ASST Santi Paolo e Carlo, Presidio San Paolo University Hospital, University of Milan Milan, Italy.
authors.forename: Antonella
authors.initials: A
authors.lastname: d'Arminio Monforte
authors.affiliation: Unit of Clinical Psychology, Department of Health Sciences, University of MilanMilan, Italy; Unit of Clinical Psychology, ASST Santi Paolo e Carlo, Presidio San Paolo University HospitalMilan, Italy.
authors.forename: Elena
authors.initials: E
authors.lastname: Vegni
keywords: HAART; HIV; IPQ-R; adherence; illness representations; patient engagement; virologic success